A New Risk Score to Predict 1-Year Mortality in Acute Non-ST Elevation Myocardial Infarction

Park, Jin Hee; Park, In Hyae; Jeong, Myung Ho; Lee, Sook Ja; Jang, Soo Yong; Cho, Jae Young; Jeong, Hae Chang; Lee, Ki Hong; Park, Keun-Ho; Sim, Doo Sun; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun

doi:2015.88.2.168

Korean J Med > Volume 88(2); 2015 > Article

Original Article

The Korean Journal of Medicine 2015;88(2):168-176.
Published online February 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.2.168

A New Risk Score to Predict 1-Year Mortality in Acute Non-ST Elevation Myocardial Infarction

Jin Hee Park^1,3, In Hyae Park², Myung Ho Jeong^1,4, Sook Ja Lee^1,3, Soo Yong Jang^1,4, Jae Young Cho^1,4, Hae Chang Jeong^1,4, Ki Hong Lee^1,4, Keun-Ho Park^1,4, Doo Sun Sim^1,4, Kye Hun Kim^1,4, Young Joon Hong^1,4, Hyung Wook Park^1,4, Ju Han Kim^1,4, Young Keun Ahn^1,4, Jeong Gwan Cho^1,4, Jong Chun Park^1,4

¹The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School, Korea
²Department of Nursing, Chonnam National Univeristy College of Nursing, Korea
³Department of Nursing, Chonnam National University Hospital, Korea
⁴Heart Research Center of Chonnam National University Hospital Designated by Korean Ministry of Health and Welfare and Family Affairs, Gwangju, Korea

급성 ST분절 비상승 환자의 1년 사망률 예측을 위한 새로운 위험 도구

박진희^1,3, 박인혜², 정명호^1,4, 이숙자^1,3, 장수영^1,4, 조재영^1,4, 정해창^1,4, 이기홍^1,4, 박근호^1,4, 심두선^1,4, 김계훈^1,4, 홍영준^1,4, 박형욱^1,4, 김주한^1,4, 안영근^1,4, 조정관^1,4, 박종춘^1,4

^¹전남대학교병원 심장센터
^²전남대학교 간호대학
^³전남대학교병원 간호부
^⁴보건복지부지정 전남대학교병원 심장질환치료기술개발특성화센터

Correspondence:
Myung Ho Jeong, Tel: +82-62-220-6243, Fax: +82-62-228-7174, Email: myungho@chollian.net

Received: 14 October 2013 • Revised: 13 January 2014 • Accepted: 5 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims
Accurate risk stratification is important in the management of patients with acute myocardial infarction (AMI). This study aimed to develop a new assessment tool for the prediction of 1-year mortality in patients with AMI, including biochemical markers. The author developed a new assessment tool (new risk score) that takes biochemical markers into account for 1-year mortality in patients with non-ST elevation myocardial infarction (NSTEMI) and identifies the risk factors related to 1-year mortality.
Methods
A total of 1,427 patients (65 ± 11.8 years of age, 985 males) who were admitted to the Chonnam National University Hospital with NSTEMI from November 2005 to March 2012 were retrospectively analyzed for score derivation. Multivariable Cox-regression analysis was used to select correlates of 1-year mortality that were subsequently weighted and integrated into an integer scoring system.
Results
Seven variables selected from the initial multivariate model were weighted proportionally to their respective hazard ratio for 1-year mortality; age ≥ 65 years (2 points), N-terminal pro-brain natriuretic peptide (NT pro-BNP) > 991 pg/mL (1 point), baseline left ventricular ejection fraction < 40% (1 point), high sensitivity C-reactive protein (hs-CRP) > 3 mg/dL (1 point), glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 (1 point), heart rate > 82 beats/min (2 points), and final thrombolysis In myocardial infarction flow < 3 (2 points).
Conclusions
In NSTEMI patients, our new score that incorporates seven risk factors accurately predicts the 1-year mortality. Additionally, the biochemical markers hs-CRP, NT pro-BNP, and GFR are reliable predictors of 1-year mortality.

Key Words: Myocardial infarction; Mortality; Prognosis

주제어: 급성 심근경색증; 사망률; 예후