(Circulation. 2000;101:2557.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation
Results From an International Trial of 9461 Patients
From the University Hospital Rotterdam, Rotterdam, The Netherlands (E.B., E.W.S., K.M.A., J.W.D, M.L.S.); Duke Clinical Research Institute, Durham, NC (K.S.P., K.L.L., R.A.H., R.M.C.); Queen’s Medical Centre, Nottingham, United Kingdom (R.G.W.); University of Alberta, Edmonton, Canada (W.-C.C., P.W.A.); and the Cleveland Clinic Foundation, Cleveland, Ohio (A.M.L., E.J.T.)
Correspondence to Eric Boersma, University Hospital Rotterdam, Room H543, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail boersma{at}thch.azr.nl
Background—Appropriate treatment policies should include an accurate estimate of a patient’s baseline risk. Risk modeling to date has been underutilized in patients with acute coronary syndromes without persistent ST-segment elevation.
Methods and Results—We analyzed the relation between
baseline characteristics and the 30-day incidence of death and the
composite of death or myocardial (re)infarction in 9461 patients with
acute coronary syndromes without persistent ST-segment
elevation enrolled in the PURSUIT trial [Platelet
glycoprotein IIb/IIIa in Unstable angina: Receptor
Suppression Using Integrilin (eptifibatide) Therapy]. Variables
examined included demographics, history, hemodynamic
condition, and symptom duration. Risk models were created with
multivariable logistic regression and validated by bootstrapping
techniques. There was a 3.6% mortality rate and 11.4% infarction rate
by 30 days. More than 20 significant predictors for mortality and for
the composite end point were identified. The most important baseline
determinants of death were age (adjusted 
2=95), heart
rate (2=32), systolic blood pressure
(2=20), ST-segment depression (2=20),
signs of heart failure (2=18), and cardiac enzymes
(2=15). Determinants of mortality were generally also
predictive of death or myocardial (re)infarction. Differences were
observed, however, in the relative prognostic importance of predictive
variables for mortality alone or the composite end point; for
example, sex was a more important determinant of the composite end
point (2=21) than of death alone (2=10).
The accuracy of the prediction of the composite end point was less than
that of mortality (C-index 0.67 versus 0.81).
Conclusions—The occurrence of adverse events after presentation with acute coronary syndromes is affected by multiple factors. These factors should be considered in the clinical decision-making process.
Key Words: angina • myocardial infarction • coronary disease • prognosis • risk factors
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