Association of the PURSUIT risk score with predischarge ejection fraction, angiographic severity of coronary artery disease, and mortality in a nonselected, community-based population with non-ST–elevation acute myocardial infarction

• Published in: The American heart journal 2003-11, Vol.146 (5), p.811-818
• Main Authors: Brilakis, Emmanouil S, Wright, R.Scott, Kopecky, Stephen L, Mavrogiorgos, Nikolaos C, Reeder, Guy S, Rihal, Charanjit S, Gersh, Bernard J, Williams, Brent A, Clements, Ian P
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood pressure; Cardiology. Vascular system; Cardiovascular disease; Comorbidity; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; Coronary Artery Disease - mortality; Coronary heart disease; Coronary vessels; Diabetes; Female; Fractions; Heart; Heart attacks; Heart failure; Heart rate; Humans; Hypertension; Intubation; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Older people; Peptides - therapeutic use; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Regression Analysis; Research Design; Risk Assessment - methods; Stroke Volume; Survival Rate
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(03)00455-1

The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) risk score was derived from the PURSUIT trial population for 30-day mortality prediction. The PURSUIT risk score was calculated for 337 consecutive Olmsted County residents with non-ST–elevation acute myocardial infarction admitted to the coronary care unit of our institution from 1988 through 1998. Predischarge ejection fraction (EF) measurement was available for 246 patients (73%). After excluding patients with prior coronary artery bypass graft surgery (n = 42), 219 patients (65%) had coronary angiography within 30 days of admission. Mortality at 30 days was 8.9%. Among 30-day survivors, mortality at 1 year was 7.9%. Mean age was 70 ± 13 years, and 37% of patients were women. Mean predischarge EF was 52% ± 16%. Patients with higher PURSUIT risk score had lower EF ( P < .001). Three-vessel (≥70% stenosis in all 3 coronary arteries) or left main (≥50% stenosis) coronary artery disease was present in 60 of 219 patients (27%) who had coronary angiography. Higher PURSUIT risk score was associated with greater likelihood of 3-vessel or left main disease ( P < .001). The PURSUIT risk score had very good predictive accuracy for both early (30-day, C-statistic = 0.78) and late (30-day to 1-year, C-statistic = 0.77) mortality. The PURSUIT risk score correlates with EF, angiographic severity of coronary artery disease, and short- and long-term mortality of nonselected patients with non-ST–elevation acute myocardial infarction.