Abstract 2264: The Most Important Predictors of Mortality in Chest Pain Patients Are Not Included in Many Non-ST elevation Acute Coronary Syndrome Risk Scores
Background: Many predictive scoring systems have been developed for identifying high risk ACS patients (pts). However, most studies are limited by failure to include pts with renal failure and CHF. Furthermore, ejection fraction (EF), one of the most important predictors of mortality, is frequently not measured or included.
Methods: Consecutive pts admitted for MI exclusion without ST elevation on the initial ECG underwent serial marker assessment, including TnI. CHF was assessed at the time of admission using physical exam and chest x-ray findings. EF ≤40% was considered abnormal. Multivariate analysis was performed to determine significant predictors of 1 year mortality.
Results: Over a 4 year period, 4,343 consecutive pts without ST elevation on the initial ECG were admitted, of whom 3,584 (83%, including 94% of those who were TnI (+)) had EF assessed. A total of 652 pts (18%) had TnI elevations. Independent multivariate predictors of mortality are shown in the Table⇓. A history of coronary disease was not predictive of death.
Conclusions: Variables frequently not included in risk scoring systems are among the most important predictors of mortality.