Ergometric score systems after myocardial infarction: Prognostic performance of the Duke Treadmill Score, veterans administration medical center score, and of a novel score system, GISSI-2 index, in a cohort of survivors of acute myocardial infarction

Massimo Villella, Alessandro Villella, Luigi Santoro, Eugenio Santoro, Maria Grazia Franzosi, Aldo Pietro Maggioni

Research output: Contribution to journalArticle

Abstract

Background: The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. Methods: Patients of the GISSI-2 Study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. Results: Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P ≤ .0001); VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P ≤ .0001); GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P ≤ .0001). The results of multivariate analysis (relative risk [RR] and 95% CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). Conclusions: The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.

Original languageEnglish
Pages (from-to)475-483
Number of pages9
JournalAmerican Heart Journal
Volume145
Issue number3
DOIs
Publication statusPublished - Mar 1 2003

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United States Department of Veterans Affairs
Survivors
Myocardial Infarction
Veterans
Fibrinolytic Agents
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Ergometric score systems after myocardial infarction : Prognostic performance of the Duke Treadmill Score, veterans administration medical center score, and of a novel score system, GISSI-2 index, in a cohort of survivors of acute myocardial infarction. / Villella, Massimo; Villella, Alessandro; Santoro, Luigi; Santoro, Eugenio; Franzosi, Maria Grazia; Maggioni, Aldo Pietro.

In: American Heart Journal, Vol. 145, No. 3, 01.03.2003, p. 475-483.

Research output: Contribution to journalArticle

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title = "Ergometric score systems after myocardial infarction: Prognostic performance of the Duke Treadmill Score, veterans administration medical center score, and of a novel score system, GISSI-2 index, in a cohort of survivors of acute myocardial infarction",
abstract = "Background: The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. Methods: Patients of the GISSI-2 Study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. Results: Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6{\%}, moderate risk 1.8{\%}, high risk 3.4{\%} (P ≤ .0001); VAMCS: low risk 0.6{\%}, moderate risk 1.9{\%}, high risk 4.7{\%} (P ≤ .0001); GISSI-2 Index: low risk 0.5{\%}, moderate risk 1.9{\%}, high risk 6.1{\%} (P ≤ .0001). The results of multivariate analysis (relative risk [RR] and 95{\%} CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). Conclusions: The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.",
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T2 - Prognostic performance of the Duke Treadmill Score, veterans administration medical center score, and of a novel score system, GISSI-2 index, in a cohort of survivors of acute myocardial infarction

AU - Villella, Massimo

AU - Villella, Alessandro

AU - Santoro, Luigi

AU - Santoro, Eugenio

AU - Franzosi, Maria Grazia

AU - Maggioni, Aldo Pietro

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N2 - Background: The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. Methods: Patients of the GISSI-2 Study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. Results: Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P ≤ .0001); VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P ≤ .0001); GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P ≤ .0001). The results of multivariate analysis (relative risk [RR] and 95% CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). Conclusions: The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.

AB - Background: The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. Methods: Patients of the GISSI-2 Study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. Results: Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P ≤ .0001); VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P ≤ .0001); GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P ≤ .0001). The results of multivariate analysis (relative risk [RR] and 95% CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). Conclusions: The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.

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