Am J Cardiovasc Dis 2013;3(1):39-52

Original Article
Predictive models for short- and long-term adverse outcomes follow-ing
discharge in a contemporary population with acute coronary syn-dromes

Dharam J Kumbhani, Brian J Wells, A Michael Lincoff, Anil Jain, Susana Arrigain, Changhong Yu, Marlene Goormastic,
Stephen G Ellis, Eugene Blackstone, Michael W Kattan

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences,
Cleveland Clinic, Cleveland, OH; Information Technology, Cleveland Clinic, Cleveland, OH

Received December 25, 2012; Accepted January 23, 2013; Epub February 17, 2013; Published February 27, 2013

Abstract: Although numerous risk-prediction models exist in patients presenting with acute coronary syndromes (ACS),
they are subject to important short-comings, including lack of contemporary information. Short-term models are frequently
biased by in-hospital events. Accordingly, we sought to create contemporary risk-prediction models for clinical outcomes
following ACS up to 1 year following discharge. Models were constructed for death at 30 days and 1 year, death/myocardial
infarction (MI)/revascularization at 30 days and death/MI at 1 year in consecutive patients presenting with ACS at our
institution between 2006 and 2008, and discharged alive. Logistic regression was used to model the 30 day outcomes
and Cox proportional hazards were used to model the 1 year outcomes. No linearity assumptions were made for
continuous variables. The final model coefficients were used to create a prediction nomogram, which was incorporated
into an online risk calculator. A total of 2,681 patients were included, of which about 9.5% presented with ST-elevation MI.
All-cause mortality was 2.6% at 30 days and 13% at 1 year. Demographic, past medical history, laboratory,
pharmacological and angiographic parameters were identified as being predictive of adverse ischemic outcomes at 30
days and 1 year. The c-indices for these models ranged from 0.73 to 0.82. Our study thus identified risk factors that are
predictive of short- and long-term ischemic and revascularization outcomes in contemporary patients with ACS, and
incorporated them into an easy-to-use online calculator, with equal or better discriminatory power than currently available
models. (AJCD1212004).

Keywords: Mortality, myocardial infarction, predictors, registry, revascularization

Address correspondence to: Dr. Michael W Kattan, Department of Quantitative Health Sciences, Cleveland Clinic, 9500
Euclid / JJN3-01,Cleveland, OH 44195, USA. Phone: 216-539-4731; Fax: 216-445-2781; E-mail: kattanm@ccf.org
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