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Does Timing of PCI
Impact Efficacy or
Safety Outcomes?
NCDR Study Validates Updated
In-Hospital Mortality Risk Model
For MI Patients
The ACTION Registry-GWTG in-hospital mortality risk model for myocardial
infarction (MI) patients has been updated to include cardiac arrest and has
been validated as a robust instrument
for risk adjustment and benchmarking
of mortality outcomes, according to a
study published Aug. 1 in JACC.
Using data from the ACTION
Registry-GWTG, researchers examined
the records of 243,440 patients from
655 hospitals between January 2012
and December 2013 to create the risk
model. The new model replaces an earlier version, which was based on 2007
and 2008 data, and now includes age;
heart rate; systolic blood pressure; presentation after cardiac arrest, in cardiogenic shock, or in heart failure; type of
MI; and the blood levels of creatinine
and troponin.
Results showed that the overall
in-hospital mortality rate was 4.6%.
The risk scores varied considerably,
ranging from a less than 1% chance
of dying for younger MI patients
without other risk factors and not
experiencing cardiac arrest to a more
than 50% chance of dying for older
patients with many other risk factors
and presenting after cardiac arrest.
CardioSource.org/CSWNInterventions
Robert McNamara, MD, MHS, the
study’s lead author, says the model
performed well across a broad range
of subgroups, including those with
and without cardiac arrest and with
and without other high-risk characteristics, illustrating the value of the
model for benchmarking mortality
outcomes even for hospitals caring
for different types of patients. He
adds that “adjusting for cardiac arrest
among heart patients is critically
important and enables a fairer assessment for hospitals that care for these
patients.” Furthermore, the model
should enhance research into best
practices to further reduce mortality
in MI patients, he notes.
In an accompanying editorial, Peter
W.F. Wilson, MD, and Ralph B.
D’Agostino Sr., PhD, explain that the
study’s results show “the dynamic nature of health risk appraisals,” in that
there is now “extensive information
related to risk factors, recent medications, a history of coronary d