Validated risk score predicts the development of congestive heart failure after presentation with unstable angina or non-ST-elevation myocardial infarction: results from OPUS-TIMI 16 and TACTICS-TIMI 18.
BACKGROUND
Few data are available about development of congestive heart failure (CHF) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). We developed and validated a risk score to predict which patients will develop CHF.


METHODS
A subset of 4681 patients from the Orbofiban in Patients With Unstable Coronary Syndromes-Thrombolysis in Myocardial Infarction (OPUS-TIMI 16) trial with UA/NSTEMI and without a history of CHF were included in this analysis and stratified according to the development of CHF at 10 months. A risk score was created from significant variables and validated in the Treat Angina With Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction (TACTICS-TIMI 18) trial. B-type natriuretic peptide (BNP) was then added to the initial multivariate analysis and validated in the TACTICS-TIMI 18 trial.


RESULTS
The incidence of CHF at 30 days was 4.9%, and at 10 months it was 5.6%. Significant variables on multivariate analysis included age >65 years, heart rate >100 beats/min, history of diabetes mellitus, lateral electrocardiographic changes, and history of angiographically confirmed coronary artery disease. The risk of CHF increased 10-fold across the number of risk factors (P <.001). When validated in the TACTICS-TIMI 18 trial, the risk score was significantly associated with CHF at 6 months (P =.01). The median BNP value doubled across the number of risk factors (P <.001 for trend). The addition of BNP to the risk score improved its discriminatory capacity.


CONCLUSIONS
In patients with UA/NSTEMI, a simple clinical risk score can aid in assessing the risk of developing CHF. BNP adds to the predictive capacity of this risk score. This score may assist in identifying patients who warrant more careful monitoring and therapy for CHF prevention inhospital and during follow-up.
Wylie
John V
JV
Division of Cardiology, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Mass 02215, USA. jwylie@bidmc.harvard.edu
Murphy
Sabina A
SA
Morrow
David A
DA
de Lemos
James A
JA
Antman
Elliott M
EM
Cannon
Christopher P
CP
D000368:Aged; D000789:Angina, Unstable / Q000150:complications*; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004562:Electrocardiography; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors