The National Registry of Myocardial Infarction (NRMI) developed a model for mortality in patients with non-ST elevation myocardial infarction. This can help identify patients who may benefit from more aggressive management.
Parameters:
(1) age and gender
(2) admission diagnosis unstable angina
(3) ST-segment depression on admission
(4) systolic blood pressure and heart rate
(5) Killip class for heart failure
(6) past medical history (7 items)
Parameter |
Finding |
Points |
---|---|---|
age and gender |
>= 65 years |
3 |
|
female and < 65 years |
1 |
|
male and < 65 years |
0 |
admission diagnosis unstable angina |
no |
2 |
|
yes |
0 |
ST segment depression on admission |
no |
0 |
|
yes |
1 |
systolic blood pressure and heart rate |
systolic blood pressure < 120 mm Hg or heart rate > 100 beats per minute |
2 |
|
systolic blood pressure >= 120 mm Hg and heart rate <= 100 beats per minute |
0 |
Killip class |
I (no heart failure) |
0 |
|
II, III or IV |
1 |
history of renal insufficiency |
no |
0 |
|
yes |
1 |
history of congestive heart failure |
no |
0 |
|
yes |
1 |
history of chronic lung disease |
no |
0 |
|
yes |
1 |
history of hypercholesterolemia |
no |
1 |
|
yes |
0 |
history of hypertension |
no |
1 |
|
yes |
0 |
history of current smoking |
no |
1 |
|
yes |
0 |
history of previous percutaneous intervention |
no |
1 |
|
yes |
0 |
where:
• In the table from Peterson et al the age factor is misprinted as "> 65 years".
• For description of Killip class see 06.08.12
total risk score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the greater the mortality rate.
Risk Score |
Mortality Rate |
---|---|
0 to 6 |
2% |
7 |
6% |
8 |
8% |
9 |
12% |
10 |
15% |
11 |
20% |
>= 12 |
24% |
from Dong et al (2001)
Risk Score |
Mortality Rate With Early Use GP IIb/IIIa Inhibitor |
Mortality Rate Without Early Use GP IIb/IIIa Inhibitor |
---|---|---|
0 to 5 |
0.5% |
1.5% |
6 |
1.6% |
2.5% |
7 |
1.8% |
3.8% |
8 |
3.6% |
6.5% |
9 |
4.8% |
9% |
10 |
9% |
12% |
>= 11 |
16% |
18.8% |
from Peterson et al (2003), Figure 1 page 49
Purpose: To evaluate a patient with a non-ST elevation myocardial infarction using the NRMI NSTE risk model for mortality.
Specialty: Cardiology
Objective: risk factors, severity, prognosis, stage, selection
ICD-10: I20, I21,