Abstract 15726: A Risk Model to Predict Need for ICU Utilization in Patients With NSTEMI
Introduction: Hospital rates of intensive care unit (ICU) utilization for patients presenting with non-ST elevation myocardial infarction (NSTEMI) vary widely, and no existing risk score has been designed to guide ICU triage. In this study, we created a risk model to identify patient characteristics that predict clinical deterioration mandating ICU care for patients presenting with hemodynamically stable NSTEMI.
Methods: Using data from the ACTION Registry-GWTG linked to Medicare data, we identified NSTEMI patients ≥ age 65 and excluded those with cardiogenic shock or cardiac arrest on presentation. Patients with subsequent cardiac arrest, shock, respiratory failure, stroke, atrioventricular block requiring treatment, or death during the index hospitalization (identified either on the ACTION data collection form or by claims data) were defined as conditions requiring ICU level care. We used multivariable logistic regression with backward selection to identify variables present on admission that predicted development of a condition mandating ICU care.
Results: Of 29,973 patients in the linked data set, 4,242 (14.2%) developed a complication mandating ICU care. Eleven variables present on admission were significantly associated with the development of 1 or more of these complications in multivariate modeling (Table). The c-statistic was 0.73. Of patients in the lowest decile of risk, 3.3% had an observed complication requiring ICU care during the index hospitalization, compared with 36.7% of patients in the highest decile.
Conclusions: Variables present on admission effectively predict need for ICU level care. A clinical risk score based on these variables could help hospitals effectively triage higher-risk patients to the ICU before complications develop.
Author Disclosures: A.C. Fanaroff: Research Grant; Modest; Gilead Sciences, Inc.. A.Y. Chen: None. L. Thomas: None. E.D. Peterson: Research Grant; Modest; Janssen, Eli Lilly. Consultant/Advisory Board; Modest; Astra Zeneca, Merck, Janssen, Boehringer Ingelheim, Bayer. L.K. Newby: None. E.A. Amsterdam: None. M.N. Kosiborod: Research Grant; Modest; American Heart Association, Gilead Sciences, Genentech, Sanofi-Aventis, and Eisai. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly, Amgen, Regeneron, Takeda, Edwards Lifesciences, Gilead Sciences, Roche, Genentech. J.A. De Lemos: Consultant/Advisory Board; Modest; Roche Diagnostics, Abbott Diagnostics. Research Grant; Significant; Abbott Diagnostics. Consultant/Advisory Board; Significant; Simen’s Health Care, Radiometer. K.N. Garratt: None. T.Y. Wang: Research Grant; Modest; Gilead Sciences, Eli Lilly, Daiichi Sanyo, Astra Zeneca, Boston Scientific, Regeneron, GlaxoSmithKline. Honoraria; Modest; Astra Zeneca, Eli Lilly.
- © 2016 by American Heart Association, Inc.