NSTEMI Risk for ICU Complications Predicted Using ACTION ICU Risk Score

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The ACTION ICU risk score was developed using variables present at hospital admission to predict complications that would require ICU care in patients with NSTEMI.
The ACTION ICU risk score was developed using variables present at hospital admission to predict complications that would require ICU care in patients with NSTEMI.

An integer risk score was able to quantify the risk for complications requiring a visit to the intensive care unit (ICU) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), according to the results of a study published in the Journal of the American Heart Association.

ACTION (the Acute Coronary Treatment and Intervention Outcomes Network) ICU risk score was developed using input variables present at hospital admission to predict complications that would require ICU care. The ACTION Registry was used in tandem with Medicare data to identify patients with NSTEMI and risk scores calculated and ICU events tracked.

Of the 29,973 patients with NSTEMI (median age, 78 years; 46.7% women), a complication that required ICU-level care developed in 14%.

When patient risk was predicted using the model, the likelihood of a complication developing that required ICU care increased >10-fold from the lowest to the highest scores, from 3.4% to 39.3%. Overall, 14.6% of patients had an ACTION ICU risk score ≤2, which corresponded to a very low likelihood for clinical deterioration requiring ICU care; 48.5% of patients had a score ≤5, which corresponded to a <10% risk of requiring ICU care; and 11.3% of patients had an ACTION ICU risk score ≥12, which corresponded to a >30% risk of requiring ICU care.

The study authors wrote, “This risk score is of clinical importance given that 43% of patients with NSTEMI without cardiogenic shock or cardiac arrest are treated in the ICU in contemporary practice, yet limited and expensive ICU resources may only be needed in a smaller proportion of these patients.”

They added, “The use of this objective risk stratification tool may help hospitals effectively use limited ICU resources while ensuring that high-risk patients are cared for safely.”

Disclosures: Several authors report financial relationships with various pharmaceutical companies, all outside of the submitted work.

Reference

Fanaroff AC, Chen AY, Thomas LE, et al. Risk score to predict need for intensive care in initially hemodynamically stable adults with non–ST-segment elevation myocardial infarction [published May 25, 2018]. J Am Heart Assoc. doi: 10.1161/JAHA.118.008894

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