A new scoring system to stratify risk in unstable angina.
BACKGROUND
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. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power.


METHODS
In 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).


RESULTS
ST-segment deviation on the electrocardiogram, age > or = 70 years, previous bypass surgery and troponin T > or = 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).


CONCLUSIONS
This 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.
Piombo
Alfredo C
AC
D.I.C. (Development and Investigation in Cardiology) Group, Buenos Aires, Argentina. apiombo@intramed.net.ar
Gagliardi
Juan A
JA
Guetta
Javier
J
Fuselli
Juan
J
Salzberg
Simón
S
Fairman
Enrique
E
Bertolasi
Carlos
C
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000097:blood / Q000150:complications* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology* / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T; D002097:C-Reactive Protein