{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:12:33Z","timestamp":1792696353361,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,6,5]]},"abstract":"\n Background<\/jats:title>\n \n Intensive care unit (\n ICU<\/jats:styled-content>\n ) use for initially stable patients presenting with non\u2013ST\u2010segment\u2013elevation myocardial infarction (\n NSTEMI<\/jats:styled-content>\n ) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high\u2010risk patients with\n NSTEMI<\/jats:styled-content>\n for\n ICU<\/jats:styled-content>\n admission.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with\n NSTEMI<\/jats:styled-content>\n aged \u226565 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring\n ICU<\/jats:styled-content>\n care were defined as subsequent development of cardiac arrest, shock, high\u2010grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION)\n ICU<\/jats:styled-content>\n risk score) that uses variables present at hospital admission to predict requirement for\n ICU<\/jats:styled-content>\n care. Of 29\u00a0973 patients with\n NSTEMI<\/jats:styled-content>\n , 4282 (14%) developed a complication requiring\n ICU<\/jats:styled-content>\n \u2010level care, yet 12\u00a0879 (43%) received care in an\n ICU<\/jats:styled-content>\n . Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease,\n ST<\/jats:styled-content>\n \u2010segment depression, and age had statistically significant associations with requirement for\n ICU<\/jats:styled-content>\n care after adjusting for other risk factors. The ACTION\n ICU<\/jats:styled-content>\n risk score had a C\u2010statistic of 0.72. It identified 11% of patients as having very high risk (>30%) of developing complications requiring\n ICU<\/jats:styled-content>\n care and 49% as having low likelihood (<10%) of requiring an\n ICU<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The ACTION\n ICU<\/jats:styled-content>\n risk score quantifies the risk of initially stable patients with\n NSTEMI<\/jats:styled-content>\n developing a complication requiring\n ICU<\/jats:styled-content>\n care, and could be used to more effectively allocate limited\n ICU<\/jats:styled-content>\n resources.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008894","type":"journal-article","created":{"date-parts":[[2018,5,25]],"date-time":"2018-05-25T09:15:14Z","timestamp":1527239714000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Risk Score to Predict Need for Intensive Care in Initially Hemodynamically Stable Adults With Non\u2013ST\u2010Segment\u2013Elevation Myocardial Infarction"],"prefix":"10.1161","volume":"7","author":[{"given":"Alexander C.","family":"Fanaroff","sequence":"first","affiliation":[{"name":"Division of Cardiology, Duke University, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita Y.","family":"Chen","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laine E.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen S.","family":"Pieper","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk N.","family":"Garratt","sequence":"additional","affiliation":[{"name":"Center for Heart and Vascular Health, Christiania Care Health System, Newark, DE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Kristin","family":"Newby","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"de Lemos","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Texas\u2013Southwestern, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail N.","family":"Kosiborod","sequence":"additional","affiliation":[{"name":"St Luke's Mid\u2010America Heart Institute University of Missouri\u2013Kansas City, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezra A.","family":"Amsterdam","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California (Davis), Sacramento, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.09.003"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.11.020"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312469122"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.3855"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181b090d0"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.3881"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.22.2557"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.10.004"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.200261"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.108.847145"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.11.048"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.6409"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.04.002"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.1998"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200210000-00010"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/73.1.13"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-19425-7"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(01)00341-9"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199606063342303"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.153387"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.05.049"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.611186"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.100.6.1619"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(02)02186-0"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.10.038"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.828541"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826890b0"},{"key":"e_1_3_4_32_2","unstructured":"Centers for Medicare & Medicaid Services . 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