1. Predictors of ten-year event-free survival in patients with acute myocardial infarction (from the Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study on myocardial infarction).
- Author
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Berton G, Cordiano R, Cavuto F, Giacomini G, De Toni R, and Palatini P
- Subjects
- Aged, Confidence Intervals, Disease-Free Survival, Female, Follow-Up Studies, Humans, Italy epidemiology, Logistic Models, Male, Middle Aged, Myocardial Infarction blood, Odds Ratio, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Factors, Sensitivity and Specificity, Survival Rate, Time Factors, Inpatients statistics & numerical data, Myocardial Infarction diagnosis, Myocardial Infarction mortality
- Abstract
The long-term event-free survival (EFS) after acute myocardial infarction (AMI) is largely uninvestigated. We analyzed noninvasive clinical variables in association with long-term EFS after AMI. The present prospective study included 504 consecutive patients with AMI at 3 hospitals from 1995 to 1998 (Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study). Thirty-seven variables were examined, including demographics, cardiovascular risk factors, in-hospital characteristics, and blood components. The end point was 10-year EFS. Logistic and Cox regression models were used to identify the predictive factors. We compared 3 predictive models according to the goodness of fit and C-statistic analyses. At enrollment, the median age was 67 years (interquartile range 58 to 75), 29% were women, 38% had Killip class >1, and the median left ventricular ejection fraction was 51% (interquartile range 43% to 60%). The 10-year EFS rate was 19%. Both logistic and Cox analyses identified independent predictors, including young age (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p = 0.0006), no history of angina (hazard ratio 1.4, 95% confidence interval 1.1 to 1.8, p = 0.009), no previous myocardial infarction (hazard ratio 1.4, 95% confidence interval 1.1 to 1.7, p = 0.01), high estimated glomerular filtration rate (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.001), low albumin/creatinine excretion ratio (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p <0.0001), and high left ventricular ejection fraction (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.006). These variables had greater predictive power and improved the predictive power of 2 other models, including Framingham cardiovascular risk factors and the recognized predictors of acute heart damage. In conclusion, 10-year EFS was strongly associated with 4 factors (ABC model) typically neglected in studies of AMI survival, including estimated glomerular filtration rate, albumin/creatinine excretion ratio, a history of angina, and previous myocardial infarction. This model had greater predictive power and improved the power of 2 other models using traditional cardiovascular risk factors and indicators of heart damage during AMI., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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