Copyright © 2000 by the European Society of Cardiology.
Identifying the risk of death following hospital discharge in patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed
a University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, U.K.
b University Division of Cardiovascular Medicine, Queens Medical Centre, Nottingham, U.K.
c Trent Institute of Health Services Research, Queens Medical Centre, Nottingham, U.K.
revised June 11, 1999; accepted June 16, 1999
Abstract
Aims To describe clinical factors, available at the time of discharge, that predicted survival of patients admitted with a suspected acute myocardial infarction in whom the diagnosis was not confirmed.
Methods and Results A cohort study based on the Nottingham Heart Attack Register of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was identification of high and low mortality risk groups over 5 years of follow-up. Overall 5-year survival was 58% (95% CI 56 to 60%). Having abnormal cardiac enzyme changes or an abnormal ECG that was insufficient to meet established diagnostic criteria of myocardial infarction, or both, identified three groups with a 5 year survival of 77%, 60% or 51%. Multivariate methods were used to develop a risk score from seven variables available at the time of discharge (age, sex, past history of myocardial infarction, ECG abnormalities, cardiac enzyme abnormalities, Killip score of 2 or 3 on admission and being discharged on a diuretic). Quartiles of this risk score then identified four groups with 5 year survival ranging from 89% to 25%.
Conclusion Among the study cohort, it was possible to identify subgroups with a markedly different risk of subsequent mortality from clinical indicators that were readily available at the time of hospital discharge. Risk stratification has the potential to improve targeting of subsequent secondary preventive efforts, but further work is required to ascertain whether cardiovascular risk can be modified through a more intensive approach to management.
Key Words: Suspected myocardial infarction, survival, risk stratification
f1 Correspondence: Dr C. J. Packham, University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, NG7 2UH, U.K.
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