A simple risk score based on ST-segment deviation, age ≥ 70 years, previous bypass surgery, and positive troponin T identified high-risk unstable angina patients with a 44.7% incidence of in-hospital death, AMI, or refractory angina compared to 6.0% in low-risk patients.
Cohort (n=715)
Yes
Can a new scoring system stratify the risk of in-hospital adverse events in patients with unstable angina?
A simple 10-point scoring system using age, ST deviation, prior CABG, and troponin T effectively stratifies in-hospital risk in patients with unstable angina.
Effect estimate: OR 12.6 (95% CI 5.9-26.8)
Absolute Event Rate: 44.7% vs 6%
p-value: p=<0.001
BACKGROUND: We performed this study to develop a new scoring system to stratify different levels of risk in patients admitted to hospital with a diagnosis of unstable angina (UA), which is a complex syndrome that encompasses different outcomes. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power. METHODS: In a first phase, 473 patients were prospectively analyzed to determine which factors were significantly associated with the in-hospital occurrence of refractory ischemia, acute myocardial infarction (AMI) or death. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 242 patients and it was finally applied to the entire population (n = 715). RESULTS: ST-segment deviation on the electrocardiogram, age > or = 70 years, previous bypass surgery and troponin T > or = 0.1 ng/mL were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. The incidence of the triple end-point was 6 %, 19.2 % and 44.7 % respectively, and the figures for AMI or death were 2 %, 11.4 % and 27.6 % respectively (p < 0.001). CONCLUSIONS: This new scoring system is simple and easy to achieve. It allows a very good stratification of risk in patients having a clinical diagnosis of UA. They may be divided in three categories, which could be of help in the decision-making process.
Piombo et al. (Wed,) conducted a cohort in Unstable angina (n=715). Risk scoring system (ST deviation, age ≥70, previous CABG, troponin T ≥0.1 ng/mL) vs. Low risk category was evaluated on Triple end-point (in-hospital death, acute myocardial infarction, or refractory angina) (OR 12.6, 95% CI 5.9-26.8, p=<0.001). A simple risk score based on ST-segment deviation, age ≥ 70 years, previous bypass surgery, and positive troponin T identified high-risk unstable angina patients with a 44.7% incidence of in-hospital death, AMI, or refractory angina compared to 6.0% in low-risk patients.