Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems. PAEEC Group.

OBJECTIVE

To compare the Acute Physiology, Age and Chronic Health Evaluation (APACHE) III with the Simplified Acute Physiology Score (SAPS II) in discriminating in-hospital mortality for intensive care unit (ICU) patients with acute myocardial infarction (AMI).

DESIGN

Prospective, observational, multicenter study.

SETTING

70 Spanish ICUs.

PATIENTS AND PARTICIPANTS

1711 patients with AMI and representative of Spanish ICUs.

MEASUREMENTS AND RESULTS

APACHE III score, APACHE III system probability of death (APACHE III probability), SAPS II score and in-hospital mortality were noted for each patient. Two hundred and twenty three (13.0 %) patients died in the hospital. The sensitivity (+/- SE), specificity (+/- SE), and accuracy (+/- SE) for the APACHE III score were, respectively, 75.8 +/- 2.9, 75.9 +/- 1.1, and 75.9 +/- 1.0. The corresponding figures for APACHE III probability were 75.3 +/- 2.9, 79.2 +/- 1.1, and 78.7 +/- 1.0, and for SAPS II 72.2 +/- 3.0, 75.9 +/- 1.1, and 75.4 +/- 1.0.

CONCLUSIONS

The results indicate good discrimination by the three tests. APACHE III probability shows a statistically significant improvement in accuracy and specificity when compared with the two scores.