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01.09.2010 | Original

APACHE-II score and Killip class for patients with acute myocardial infarction

verfasst von: Juan Mercado-Martínez, Ricardo Rivera-Fernández, Eduardo Aguilar-Alonso, Ángel García-Alcántara, Andrés Estivill-Torrull, Agustín Aranda-León, María Consuelo Guia-Rambla, Mari Paz Fuset-Cabanes, GRUPO ARIAM

Erschienen in: Intensive Care Medicine | Ausgabe 9/2010

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Abstract

Objective

To analyse the influence on the prognosis of intensive care unit (ICU) patients with acute myocardial infarction (AMI): prognostic index score, Killip class, AMI site, thrombolysis and other variables that might improve prognostic capacity and functioning of the APACHE-II index.

Design

Cohort study using prospectively gathered ARIAM project data.

Setting

ICUs from 129 Spanish hospitals.

Patients

ICU-admitted AMI patients in ARIAM database during 4-year period were retrospectively studied.

Measurements and main results

The sample comprised 6,458 patients, 76.8% males, age 64.97 ± 12.56 years, APACHE-II score 9.49 ± 7.03 points and ICU mortality 8.9%. Mortality was higher for females (p < 0.001), anterior AMI site (p < 0.001), previous AMI (p < 0.001), delay-to-hospital arrival >180 min (p = 0.003) and non-receipt of thrombolysis (p = 0.015). ICU mortality was related to age (p < 0.001) and APACHE-II score (p < 0.001). In multivariate analysis, it was related to APACHE-II (OR 1.16), age (OR 1.05), gender (OR 1.64), previous AMI (OR 1.57), anterior AMI (OR 2.05) and delay >180 min (OR 1.37). Killip class, gathered in 1,893 patients, was significantly associated with ICU mortality, and two predictive models were constructed for this group using multivariate analysis. Area under ROC curve was 0.94 in one (Killip class, age, gender, APACHE-II) versus 0.92 in the other (same variables without APACHE-II).

Conclusions

APACHE-II score and Killip class are useful for assessing the severity of patients with AMI and are complementary. Each can be used with a few commonly gathered clinical variables to construct prognostic models to assess severity. Their joint application yields a model with excellent discrimination capacity.

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Titel: APACHE-II score and Killip class for patients with acute myocardial infarction
verfasst von: Juan Mercado-Martínez
Ricardo Rivera-Fernández
Eduardo Aguilar-Alonso
Ángel García-Alcántara
Andrés Estivill-Torrull
Agustín Aranda-León
María Consuelo Guia-Rambla
Mari Paz Fuset-Cabanes
GRUPO ARIAM
Publikationsdatum: 01.09.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1832-6

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APACHE-II score and Killip class for patients with acute myocardial infarction