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Prediction of 1-year survival after thrombolysis for acute myocardial infarction in the global utilization of streptokinase and TPA for occluded coronary arteries trial.
- Source :
-
Circulation [Circulation] 2000 May 16; Vol. 101 (19), pp. 2231-8. - Publication Year :
- 2000
-
Abstract
- Background: When a patient survives thrombolysis for acute myocardial infarction, little information from large studies exists from which to estimate prognosis during follow-up visits.<br />Methods and Results: Baseline, in-hospital, and later survival data were collected from 41 021 patients enrolled in Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries, a randomized trial of 4 thrombolytic-heparin regimens with standard aspirin and beta-blockade. Cox proportional hazards models were developed to predict 1-year survival in 30-day survivors (n=37 869) from baseline clinical and ECG factors and in-hospital factors; a combined model then was developed (C-index 0.800). The model was simplified into a nomogram to predict individual outcomes (C-index 0.754). Factors reflecting demographics (advanced age, lighter weight), larger infarctions (higher Killip class, lower blood pressure, faster heart rate, longer QRS duration), cardiac risk (smoking, hypertension, prior cerebrovascular disease), and arrhythmia were important predictors of death between 30 days and 1 year. Black race was associated with a substantial increase in risk after considering other factors. Revascularization was associated with reduced risk between 30 days and 1 year.<br />Conclusions: When evaluating a patient who has survived acute infarction treated with thrombolysis, clinicians can estimate the likelihood of survival from factors easily measured during admission. Although many risk factors clearly relate to age, left ventricular dysfunction, or clinical instability, black race is an unexplained risk factor requiring further examination.
- Subjects :
- Aged
Female
Humans
Male
Middle Aged
Myocardial Infarction mortality
Prognosis
Proportional Hazards Models
Survival Analysis
Coronary Disease drug therapy
Fibrinolytic Agents therapeutic use
Myocardial Infarction therapy
Streptokinase therapeutic use
Thrombolytic Therapy
Tissue Plasminogen Activator therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 101
- Issue :
- 19
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 10811588
- Full Text :
- https://doi.org/10.1161/01.cir.101.19.2231