FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease.
OBJECTIVE
To develop a scoring system for risk stratification and evaluation of the effect of an early invasive strategy for treatment of unstable coronary artery disease (CAD).


METHODS
Retrospective analysis of a randomised study (FRISC II; fast revascularisation in instability in coronary disease).


METHODS
58 Scandinavian hospitals.


METHODS
2457 patients with unstable CAD from the FRISC II study.


METHODS
One year rates of mortality and death/myocardial infarction (MI).


METHODS
Patients were randomly assigned to an early invasive or a non-invasive strategy. From the non-invasive cohort independent variables of death or death/MI were identified.


RESULTS
Seven factors, age > 70 years, male sex, diabetes, previous MI, ST depression, and increased concentrations of troponins and markers of inflammation (interleukin 6 or C reactive protein), were associated with an independent increased risk for death or death/MI. In patients with > or = 5 of these factors the invasive strategy reduced mortality from 15.4% (20 of 130) to 5.2% (7 of 134) (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.15 to 0.78, p = 0.006). Death/MI was also reduced in patients with 3-4 factors from 15.7% (80 of 511) to 10.8% (58 of 538) (RR 0.69, 95% CI 0.50 to 0.94, p = 0.02). Neither death nor death/MI was reduced in patients with 0-2 risk factors.


CONCLUSIONS
In unstable CAD, this scoring system based on factors independently associated with an adverse outcome can be used shortly after admission to the hospital for risk stratification and for selection of patients to an early invasive treatment strategy.
Lagerqvist
B
B
Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden. bo.lagerqvist@ucr.uas.lul.se
Diderholm
E
E
Lindahl
B
B
Husted
S
S
Kontny
F
F
Ståhle
E
E
Swahn
E
E
Venge
P
P
Siegbahn
A
A
Wallentin
L
L
D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers