Objective Although early thrombolysis reduces the risk of death in STEMI patients, mortality remains high. We evaluated factors predicting in-patient mortality for STEMI patients in a 'real-world' population.
Design Analysis of the Myocardial Infarction National Audit Project (MINAP) database using multivariate logistic regression and area under the receiver operating curve analysis.
Setting All acute hospitals in England and Wales.
Patients 34,722 STEMI patients from 1st January 2003 to 31st March 2005.
Results In-patient mortality was 10.6%. The highest odds ratios for in-patient survival were aspirin therapy given acutely and out-of-hospital thrombolysis, independently associated with a mortality risk reduction of over half. A 10-year increase in age doubled in-patient mortality risk whereas cerebrovascular disease increased it by 1.7. The risk model comprised 14 predictors of mortality, C index = 0.82 (95% CI 0.82 to 0.83, P<0.001). A simple model comprising age, systolic blood pressure (SBP) and heart rate (HR) offered a C index of 0.80 (0.79 to 0.80, P<0.001).
Conclusion The strongest predictors of in-hospital survival for STEMI were aspirin therapy given acutely and out-of-hospital thrombolysis, Previous STEMI models have focused on age, SBP and HR We have confirmed the importance of these predictors in the discrimination of death post STEMI, but also demonstrated that other potentially modifiable variables impact upon the prediction of short-term mortality.
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