Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003–2009: National Institute for Cardiovascular Outcomes Research (NICOR)
| Autor: | Paul D. Baxter, Stephanie Reynolds, Alistair S. Hall, John I Wilson, Brian A. Cattle, Karen S. Pieper, Robert West, A D Simms, John E. Deanfield, Chris Gale, Keith A.A. Fox, P D Batin |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Myocardial Infarction MEDLINE Nice Risk Assessment Severity of Illness Index Risk Factors Outcome Assessment Health Care Severity of illness Humans Medicine Registries Myocardial infarction Survival rate Aged Retrospective Studies computer.programming_language Medical Audit Wales business.industry Academies and Institutes Reproducibility of Results Retrospective cohort study Prognosis medicine.disease Survival Rate England Emergency medicine Physical therapy Female Myocardial infarction diagnosis Cardiology and Cardiovascular Medicine business Risk assessment computer |
| Zdroj: | Heart. 99:35-40 |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2012-302632 |
| Popis: | To evaluate the performance of the National Institute for Health and Clinical Excellence (NICE) mini-Global Registry of Acute Coronary Events (GRACE) (MG) and adjusted mini-GRACE (AMG) risk scores.Retrospective observational study.215 acute hospitals in England and Wales.137 084 patients discharged from hospital with a diagnosis of acute myocardial infarction (AMI) between 2003 and 2009, as recorded in the Myocardial Ischaemia National Audit Project (MINAP).Model performance indices of calibration accuracy, discriminative and explanatory performance, including net reclassification index (NRI) and integrated discrimination improvement.Of 495 263 index patients hospitalised with AMI, there were 53 196 ST elevation myocardial infarction and 83 888 non-ST elevation myocardial infarction (NSTEMI) (27.7%) cases with complete data for all AMG variables. For AMI, AMG calibration was better than MG calibration (Hosmer-Lemeshow goodness of fit test: p=0.33 vs p0.05). MG and AMG predictive accuracy and discriminative ability were good (Brier score: 0.10 vs 0.09; C statistic: 0.82 and 0.84, respectively). The NRI of AMG over MG was 8.1% (p0.05). Model performance was reduced in patients with NSTEMI, chronic heart failure, chronic renal failure and in patients aged ≥85 years.The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|