A new scoring system to stratify risk in unstable angina.

Alfredo C Piombo,Javier Guetta,Simón Salzberg,Juan A Gagliardi,Enrique Fairman,Carlos Bertolasi,Juan Fuselli

doi:10.1186/1471-2261-3-8

Abstract

BackgroundWe 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.MethodsIn 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).ResultsST-segment deviation on the electrocardiogram, age ≥ 70 years, previous bypass surgery and troponin T ≥ 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).ConclusionsThis 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.

Highlights

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
Prognosis of patients admitted to coronary care units with the clinical diagnosis of UA has strikingly improved in the last decades, but the spectrum of outcomes among different patients continues to be broad
Study population Between January 2000 and June 2001, patients admitted to coronary care units with a clinical diagnosis of UA were included in the study if they fulfilled the following criteria: a) class III-IV angina beginning in the last 2 months or previous stable angina increasing in frequency, duration of pain or occurring at lower threshold; b) last episode of pain at rest or at minimal exertion occurring in the previous 48 hours and lasting more than 10 minutes

Summary

Introduction

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. Prognosis of patients admitted to coronary care units with the clinical diagnosis of UA has strikingly improved in the last decades, but the spectrum of outcomes among different patients continues to be broad. Electrocardiographic and biochemical factors have been clearly shown to increase risk in UA, few attempts have been made to combine them in order to improve their individual prognostic accuracy [12,13]. We decided to test the prognostic value of a combination of such markers resulting in a prospectively designed score that could be capable of making a clear distinction of different clinical outcomes applied to patients coming to hospital with an UA admission diagnosis. The new score was applied in another cohort of patients consecutively admitted to several coronary care units who were not enrolled in trials of therapeutic interventions

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