Score du risque échocardiographique après un syndrome coronaire aigu

Abstract

AimsIdentify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores. MethodsWe recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months. ResultsThe echocardiographic risk score has four variables: LV-EF (RR=0.931; 95%CI=0.885–0.979, P<0.01), RV-AF (RR=0.951; 95%CI=0.903–0.999, P<0.05), iMAE-M-strain (RR=1.226; 95%CI=1.081–1.390, P<0.01) and ULCs (RR=1.151; 95%CI=1.081–1.224, P<0.01). Its discrimination capacity (AUC=0.85), greater than that of the clinical risk scores, (GRACE: AUC=0.72, TIMI: AUC=0.71 and CRUSADE: AUC=0.76). DiscussionThe risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate. ConclusionThe developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.