Journal Information
Vol. 47. Issue 9.
Pages 501-515 (September 2023)
Share
Share
Download PDF
More article options
ePub
Visits
2
Vol. 47. Issue 9.
Pages 501-515 (September 2023)
Original article
Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit
Diseño de un nuevo indicador de mortalidad en el síndrome coronario agudo al ingreso en la Unidad de Cuidados Intensivos
Visits
2
Herminia Lozano Gómeza,
Corresponding author
fiex_hermi1990@hotmail.com

Corresponding author.
, Adrián Rodríguez Garcíaa, María Ángeles Rodríguez Estebanb, Cristina López Ferrazc, María del Pilar Murcia Hernándezd, Alberto Fernández Zapatae, Esther Villarreal Tellof, Javier Ruiz Ruizg, Virginia Fraile Gutiérrezh, Lorenzo Socias Crespii, Luis Alberto Pallas Beneytoj, Beatriz Villanueva Anadóna, Elena Porcar Rodadok, Juan José Araiz Burdioa, researchers of the ARIAM-SEMICYUC registry
a Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Coordinadora Nacional del Registro ARIAM-SEMICYUC. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
c Complejo Hospitalario Universitario Nuestra Sra. de la Candelaria (Sta. Cruz de Tenerife), Spain
d Hospital Los Arcos, San Javier, Murcia, Spain
e Hospital de Torrevieja, Torrevieja, Alicante, Spain
f Hospital Universitari i Politècnic La Fe, Valencia, Spain
g Hospital de Llíria, Llíria, Valencia, Spain
h Hospital Universitario del Río Hortega, Valladolid, Spain
i Hospital Son Llàtzer, Palma de Mallorca, Baleric Islands, Spain
j Hospital Lluis Alcanyís de Xátiva, Xàtiva, Valencia, Balearic Islands, Spain
k Hospital de La Plana, Castellón, Spain
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Tables (3)
Table 1. Differences between the contemporaneous ARIAM population versus TIMI and GRACE.
Table 2. Variables included in the study.
Table 3. Conventional statistics: bivariate and multivariate analysis.
Show moreShow less
Additional material (6)
Abstract
Objective

To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU).

Design

A multicenter, observational descriptive study was carried out.

Participants

Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019.

Interventions

None.

Main variables of interest

Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM’s) was assessed using a Fagan test.

Results

A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (n = 605) at discharge from the ICU. The variables showing statistical significance (P < .001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM’s yielded a mean of 0.0257 (95%CI: 0.0245−0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533−0.2886) in those who died (P < .001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907−0.930). Based on the Fagan test, the ARIAM’s showed the mortality risk to be 19% (95%CI: 18%–20%) when positive and 0.9% (95%CI: 0.8%–1.01%) when negative.

Conclusions

A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.

Keywords:
Acute coronary syndrome
Mortality
Stratification
Intensive care unit
Neural networks
Resumen
Objetivo

Diseñar un Indicador de Mortalidad del síndrome coronario agudo (SCA) en el servicio de medicina intensiva (SMI).

Diseño

Estudio descriptivo observacional multicéntrico

Participantes

Pacientes con SCA ingresados en SMI incluidos en el registro ARIAM- SEMICYUC entre enero de 2013 y abril de 2019.

Intervenciones

Ninguna.

Variables de interés principales

Las variables analizadas fueron demográficas, tiempo de acceso al sistema sanitario y estado clínico. Se analizó la terapia de revascularización, los fármacos y la mortalidad. Se realizó un análisis de regresión logística de COX y posteriormente se diseñó una red neuronal. Se elaboró una curva ROC para calcula la potencia del nuevo score. Finalmente, la utilidad clínica o relevancia del Indicador ARIAM’s se evaluará mediante un Gráfico de Fagan.

Resultados

Se incluyeron 17.258 pacientes, con una mortalidad al alta del SMI del 3.5% (605). Las variables analizadas con significación estadística (P < .001) fueron introducidas en el modelo predictivo supervisado, una red neuronal artificial. El nuevo indicador ARIAM’s mostro una media de 0.0257 (95%IC 0.0245−0.0267) en los pacientes dados de alta de UCI y de 0.27085 (95%IC 0.2533−0.2886) en los que fallecieron, P < .001. El área ROC del modelo conseguido fue de 0.918 (95% IC: 0.907−0.930). El test de Fagan, se demostró que el Indicador ARIAM’s muestra que la probabilidad de exitus del 19% (95% IC: 18%–20%) cuando es positivo y de 0.9% (95% IC: 0.8%–1.01%) cuando es negativo.

Conclusiones

Es posible crear un nuevo indicador de mortalidad del SCA en el SMI que sea más exacto, reproducible y actualizable periódicamente.

Palabras clave:
Síndrome coronario agudo
Mortalidad
Estratificación
Unidad de cuidados intensivos
Redes neuronales

Article

These are the options to access the full texts of the publication Medicina Intensiva (English Edition)
Member
If you are a member of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias::
Go to the members area of the website of the SEMICYUC (www.semicyuc.org )and click the link to the magazine.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Medicina Intensiva (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Medicina Intensiva (English Edition)
Article options
Tools
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?