Modified Mid America Heart Institute Coronary Care Unit scoring system - A new comprehensive prognostic index for Coronary Care Unit patients

Background: Prediction of long-term outcomes for patients presenting with cardiac events is important, but few predictive instruments are available. We previously developed an innovative scoring system, the Mid America Heart Institute (MAHI) Coronary Care Unit (CCU) scoring system, for quantifying outcomes of patients admitted to the CCU, using clinical events rather than solely physiologic and laboratory variables. The objective of our study was to validate a refined version of this system (MAHI-2) and to explore its prognostic value, we have postulated that patients with high MAHI scores would have higher mortality and morbidity in 1-year follow-up. Material/Methods: 154 patients admitted to the CCU were followed and assigned a MAHI score based on key clinical variables and events. The patients were followed for 1 year and outcomes were analyzed based on MAHI score quartiles. Results: The mean MAHI-2 score was 14±8. Over one year, 34 patients died, 13 suffered myocardial infarction, 12 had coronary artery bypass graft, 6 had percutaneous transluminal coronary angiography, 37 had a cardiovascular-related admission, and a total of 48 (31%) suffered >1 major adverse cardiac event (MACE - death/myocardial infarction/revascularization). MACE rates increased progressively by MAHI-2 score quartile (from 21% for those in the lowest quartile, to 42% in the highest quartile; p=0.22). The risk of death was more strongly correlated with MAHI-2 score, with patients in the highest quartile being at 6-fold greater risk for death in 1 year than those in the lowest quartile (p<0.0017). Conclusions: The MAHI-2 score appears to be a useful tool for predicting 1-year clinical outcomes based on in-hospital events.