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A user-friendly risk-score for predicting in-hospital cardiac arrest among patients admitted with suspected non ST-elevation acute coronary syndrome - The SAFER-score
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.ORCID iD: 0000-0003-2247-8454
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 121, p. 41-48Article in journal (Refereed) Published
Abstract [en]

AIM: To develop a simple risk-score model for predicting in-hospital cardiac arrest (CA) among patients hospitalized with suspected non-ST elevation acute coronary syndrome (NSTE-ACS).

METHODS: Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART), we identified patients (n=242 303) admitted with suspected NSTE-ACS between 2008 and 2014. Logistic regression was used to assess the association between 26 candidate variables and in-hospital CA. A risk-score model was developed and validated using a temporal cohort (n=126 073) comprising patients from SWEDEHEART between 2005 and 2007 and an external cohort (n=276 109) comprising patients from the Myocardial Ischaemia National Audit Project (MINAP) between 2008 and 2013.

RESULTS: The incidence of in-hospital CA for NSTE-ACS and non-ACS was lower in the SWEDEHEART-derivation cohort than in MINAP (1.3% and 0.5% vs. 2.3% and 2.3%). A seven point, five variable risk score (age ≥60 years (1 point), ST-T abnormalities (2 points), Killip Class >1 (1 point), heart rate <50 or ≥100bpm (1 point), and systolic blood pressure <100mmHg (2 points) was developed. Model discrimination was good in the derivation cohort (c-statistic 0.72) and temporal validation cohort (c-statistic 0.74), and calibration was reasonable with a tendency towards overestimation of risk with a higher sum of score points. External validation showed moderate discrimination (c-statistic 0.65) and calibration showed a general underestimation of predicted risk.

CONCLUSIONS: A simple points score containing five variables readily available on admission predicts in-hospital CA for patients with suspected NSTE-ACS.

Place, publisher, year, edition, pages
2017. Vol. 121, p. 41-48
Keywords [en]
Acute coronary syndrome, In-hospital cardiac arrest, Non-ST elevation acute coronary syndrome, Risk score, Risk stratification
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-342324DOI: 10.1016/j.resuscitation.2017.10.004ISI: 000416179400019PubMedID: 28993178OAI: oai:DiVA.org:uu-342324DiVA, id: diva2:1184060
Funder
Swedish Foundation for Strategic Research Stockholm County CouncilAvailable from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-02-28Bibliographically approved

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Sundström, JohanLindahl, Bertil

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