ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION-II SCORING SYSTEM IN ACUTE MYOCARDIAL-INFARCTION - A PROSPECTIVE VALIDATION-STUDY

Objective: To study the usefulness of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system for prognostication o f inhospital mortality in acute myocardial infarction. Design: A prosp ective validation study. Setting: A medical intensive care unit (ICU) at a university hospital. Patients: Over a 3-yr period, 2,007 admissio ns of 1,714 patients with acute myocardial infarction were studied. In readmissions to the medical ICU during the same hospital stay, only t he first admission was studied. Measurements and Main Results: Mean ag e of the patients was 72 +/- 10 yrs. The medical ICU mortality rate wa s 13% and total hospital mortality rate was 16%. Mean APACHE II score was 11.6 +/- 6.5. There was a close correlation between observed and p redicted mortality rates in classes of patients with various APACHE II scores. Observed mortality in patients with scores of 20 to 24 was hi gher than the predicted mortality (p < .03). In this subgroup, 25% of the patients had a length of stay in the medical ICU of <8 hrs. Conclu sions: Inhospital mortality in patients with acute myocardial infarcti on could be accurately predicted with APACHE II scores. Prognosticatio n was not as good in patients with a length of stay in the medical ICU of <8 hrs.