Prediction of 1-Year Survival After Thrombolysis for Acute Myocardial Infarction in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries Trial

  • Robert M. Califf
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • Karen S. Pieper
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • Kerry L. Lee
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • Frans Van de Werf
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • R. John Simes
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • Paul W. Armstrong
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
  • Eric J. Topol
    From Duke Clinical Research Institute, Durham, NC (R.M.C., K.S.P., K.L.L.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.); NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia (R.J.S.); University of Alberta, Edmonton, Canada (P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).

抄録

<jats:p> <jats:italic>Background</jats:italic> —When a patient survives thrombolysis for acute myocardial infarction, little information from large studies exists from which to estimate prognosis during follow-up visits. </jats:p> <jats:p> <jats:italic>Methods and Results</jats:italic> —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 β-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. </jats:p> <jats:p> <jats:italic>Conclusions</jats:italic> —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. </jats:p>

収録刊行物

  • Circulation

    Circulation 101 (19), 2231-2238, 2000-05-16

    Ovid Technologies (Wolters Kluwer Health)

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