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(Circulation. 1999;100:599-607.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
PREDICT: A Simple Risk Score for Clinical Severity and Long-Term Prognosis After Hospitalization for Acute Myocardial Infarction or Unstable Angina
The Minnesota Heart Survey
From the Division of Epidemiology, School of Public Health (D.R.J., C.K., R.C., H.B.) and Division of Laboratory Medicine and Pathology (L.G.), University of Minnesota, Minneapolis; Stratis Health, Bloomington, Minn (M.D.); and Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, PRC (D.F.G.).
Correspondence to David R. Jacobs, Jr, PhD, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN 55454. E-mail jacobs{at}epivax.epi.umn.edu
Background—We evaluated short- and long-term mortality risks in 30- to 74-year-old patients hospitalized for acute myocardial infarction or unstable angina and developed a new score called PREDICT.
Methods and Results—PREDICT was based on information routinely
collected in hospital. Predictors abstracted from hospital record
items pertaining to the admission day, including shock, heart failure,
ECG findings, cardiovascular disease history, kidney
function, and age. Comorbidity was assessed from discharge diagnoses,
and mortality was determined from death certificates. For 1985 and 1990
hospitalizations, the 6-year death rate in 6134 patients with 0 to 1
score points was 4%, increasing stepwise to 89% for 
16 points.
Score validity was established by only slightly attenuated mortality
prediction in 3570 admissions in 1970 and 1980. When case severity was
controlled for, 6-year risk declined 32% between 1970 and 1990. When
PREDICT was held constant, 24% of those treated with
thrombolysis died in 6 years compared with 31% of
those not treated.
Conclusions—The simple PREDICT risk score was a powerful prognosticator of 6-year mortality after hospitalization.
Key Words: myocardial infarction • angina • cardiovascular diseases • thrombolysis
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