Abstract 17958: Prognostic Value of Routine Laboratory Examinations in Chronic Ischemic Heart Disease
Objective: The prognosis of patients with chronic ischemic heart disease (IHD) can be predicted by clinical and instrumental variables. We sought to investigate whether routine laboratory examinations provide an additional prognostic information.
Methods: We selected from our database a cohort of 2370 consecutive patients who underwent a complete diagnostic work-up that included clinical evaluation, laboratory examinations, EKG, two-dimensional echocardiography and coronary arteriography. The diagnosis of IHD was based on the evidence of a >75% coronary stenosis (>50% for the left main) or on the documentation of a previous myocardial infarction (MI). Patients with acute MI, significant valvular heart disease, cardiomyopathy, overt hyperthyroidism, or under hemodialysis treatment were excluded. Tested laboratory variables included: hematocrit, fasting glucose, serum creatinine, total and HDL cholesterol, triglycerides, thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4) , C-reactive protein and fibrinogen. During follow-up, a total of 1598 patients (67%) were revascularized (1166 by percutaneous coronary interventions, 517 by coronary artery bypass graft surgery, 85 by both).
Results: During follow-up (median, 46 months), 277 patients (12%) died (147 from cardiac causes) and 81 experienced a non-fatal MI. Using Cox regression analysis, the independent predictors of survival free from cardiac death and non-fatal MI were: age (p<0.0001), history of diabetes mellitus (p=0.019), left ventricular ejection fraction (p<0.001) and the number ofstenosed coronary arteries (p<0.001). Adding to the above variables those derived from laboratory examinations, fT3 (p=0.013), HDL cholesterol (p<0.001) and serum creatinine (p=0.016) showed and independent and incremental prognostic value. An fT3 value <2.1 pg/mL with TSH in the normal range (low T3 syndrome), an HDL cholesterol level <35 mg/dL, and serum creatinine levels >1,4 mg/dL were associated with an increase in the rate of cardiac events of 47%, 94%, and 53%, respectively.
Conclusion: Routine laboratory examination as fT3, HDL cholesterol and serum creatinine provide an independent and incremental prognostic information in patients with chronic IHD.
- © 2010 by American Heart Association, Inc.