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| Publications [#197839] of Daniel B. Mark
Papers Published
- LK Newby, V Hasselblad, PW Armstrong, F Van de Werf, DB Mark, HD White, EJ Topol, RM Califf, Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making.,
European heart journal, vol. 24 no. 2
(January, 2003),
pp. 182-9, ISSN 0195-668X
(last updated on 2011/11/29)
Abstract:
OBJECTIVE: We evaluated timing of adverse cardiac events after thrombolysis to guide length of stay after ST-segment elevation myocardial infarction. RESULTS: Kaplan-Meier survival curves described timing of major postinfarction complications in 41021 fibrinolytic-treated patients in GUSTO-I. Using model-fitting, these data were best explained by a mixed-exponential survival model: an acute curve describing most adverse events and a chronic curve describing a lower background rate. We replicated this strategy in 15059 fibrinolytic-treated patients in GUSTO-III. From the relation between time and events described by the model's acute curve in GUSTO-III, we proposed times for hospital discharge. The acute curve explained 97% of deaths and 68%-96% of various event composites. Of complications within 10 days, 90% of deaths and 70% of acute curve death, stroke, shock, heart failure, or reinfarction occurred by 24 h. By 2.7 days, 95% of deaths, stroke, shock, heart failure, or reinfarction occurred. Most major ventricular arrhythmias occurred within 24 h, after which the hazard curve was flat. CONCLUSIONS: Mixed-exponential survival modelling describes timing of post-infarction complications and supports discharge 4 days after uncomplicated infarction. Such time-based risk assessment could guide decision-making in other settings in which randomized studies are impractical.
Keywords:
Decision Making* • Humans • Length of Stay • Middle Aged • Myocardial Infarction • Patient Discharge* • Prognosis • Proportional Hazards Models • Risk Assessment • Risk Factors • Survival Analysis • Survival Rate • Thrombolytic Therapy • Time Factors • methods* • mortality • therapy*
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