| Prediction of 1-year survival after thrombolysis for acute myocardial infarction in the global utilization of streptokinase and TPA for occluded coronary arteries trial. | |
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MedLine Citation:
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PMID: 10811588 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: When a patient survives thrombolysis for acute myocardial infarction, little information from large studies exists from which to estimate prognosis during follow-up visits. METHODS AND RESULTS: Baseline, in-hospital, and later survival data were collected from 41 021 patients enrolled in Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries, a randomized trial of 4 thrombolytic-heparin regimens with standard aspirin and beta-blockade. Cox proportional hazards models were developed to predict 1-year survival in 30-day survivors (n=37 869) from baseline clinical and ECG factors and in-hospital factors; a combined model then was developed (C-index 0.800). The model was simplified into a nomogram to predict individual outcomes (C-index 0.754). Factors reflecting demographics (advanced age, lighter weight), larger infarctions (higher Killip class, lower blood pressure, faster heart rate, longer QRS duration), cardiac risk (smoking, hypertension, prior cerebrovascular disease), and arrhythmia were important predictors of death between 30 days and 1 year. Black race was associated with a substantial increase in risk after considering other factors. Revascularization was associated with reduced risk between 30 days and 1 year. CONCLUSIONS: When evaluating a patient who has survived acute infarction treated with thrombolysis, clinicians can estimate the likelihood of survival from factors easily measured during admission. Although many risk factors clearly relate to age, left ventricular dysfunction, or clinical instability, black race is an unexplained risk factor requiring further examination. |
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Authors:
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R M Califf; K S Pieper; K L Lee; F Van De Werf; R J Simes; P W Armstrong; E J Topol |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 101 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2000 May |
Date Detail:
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Created Date: 2000-06-16 Completed Date: 2000-06-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2231-8 Citation Subset: AIM; IM |
Affiliation:
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Duke Clinical Research Institute, Durham, NC, USA. calif001@mc.duke.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Disease / drug therapy* Female Fibrinolytic Agents / therapeutic use* Humans Male Middle Aged Myocardial Infarction / mortality, therapy* Prognosis Proportional Hazards Models Streptokinase / therapeutic use* Survival Analysis Thrombolytic Therapy* Tissue Plasminogen Activator / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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