Prediction of 1-year survival after thrombolysis for acute myocardial infarction in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries trial

Background-When a patient survives thrombolysis for acute myocardial infarc tion, little information from large studies exists from which to estimate p rognosis during follow-up visits. Methods and Results-Baseline, in-hospital, and later survival data were col lected from 41 021 patients enrolled in Global utilization of Streptokinase and TPA for Occluded Coronary Arteries, a randomized trial of 4 thrombolyt ic-heparin regimens with standard aspirin and P-blockade. Cox proportional hazards models were developed to predict 1-year survival in 30-day survivor s (n=37 869) from baseline clinical and ECG factors and in-hospital factors ; a combined model then was developed (C-index 0.800). The model was simpli fied into a nomogram to predict individual outcomes (C-index 0.754). Factor s reflecting demographics (advanced age, lighter weight), larger infarction s (higher Killip class, lower blood pressure, faster heart rate, longer QRS duration), cardiac risk (smoking, hypertension, prior cerebrovascular dise ase), and arrhythmia were important predictors of death between 30 days and 1 year. Black race was associated with a substantial increase in risk afte r considering other factors. Revascularization was associated with reduced risk between 30 days and 1 year. Conclusions-When evaluating a patient who has survived acute infarction tre ated with thrombolysis, clinicians can estimate the likelihood of survival from factors easily measured during admission. Although many risk factors c learly relate to age, left ventricular dysfunction, or clinical instability , black race is an unexplained risk factor requiring further examination.