Clinical scores and patient risk stratification in non-ST elevation acute coronary syndrome

• Published in: International journal of cardiology Vol. 146; no. 2; pp. 219 - 224
• Main Authors: Fernández-Bergés, D, Bertomeu-Gonzalez, V, Sánchez, P.L, Cruz-Fernandez, J.M, Arroyo, R, Barriales Álvarez, V, Carrasco Sánchez, F.J, Dalli, E, Castro Beiras, A, Kaski, J.C
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 21.01.2011; Elsevier
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Aged; Angina, Unstable - diagnosis; Angina, Unstable - mortality; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Death, Sudden, Cardiac - epidemiology; Electrocardiography; Female; Follow-Up Studies; Heart; Humans; Inflammatory biomarkers; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Risk scores; NSTEMI; RS; Non-ST-segment elevation myocardial infarction; High sensitivity C-reactive protein; Inflammatory biomarkers; Percutaneous coronary intervention; UA; NT proBNP; N-terminal prohormone brain natriuretic peptide; PURSUIT; Platelet glycoprotein IIb/IIIa in Unstable Angina: Receptor suppression Using Integrilin Therapy; GRACE; Thrombolysis in Myocardial Infarction; Risk scores; AMI; hs-CRP; NSTE-ACS; OR; Systemic Inflammation Evaluation in patients with NSTE-ACS; Non-ST-segment elevation acute coronary syndrome; Unstable angina; CI; ROC; Confidence interval; ACS; Receiver operating characteristic; Global Registry of Acute Cardiac Events; TIMI; SIESTA; PCI; Physician's risk assessment; Odds ratio; Acute coronary syndrome; Acute myocardial infarction; PRA; Risk score/scores; Human; Biological marker; Patient; Cardiovascular disease; Risk; Coronary heart disease; Myocardial disease; ST elevation; Risk factor; Cardiology; Stratification
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.04.016

Abstract Background Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. Methods We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, P-selectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. Results At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a “higher risk” compared to those classified as being at a “lower risk”. Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30- and 360-day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. Conclusions Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.