The risk of cardiovascular death following the first acute ischaemic syndrome: experience in Kaunas between 1997 and 2001.
The aim of our study was twofold: initially to investigate the effects of the informative value of the variables of the acute period on the risk of cardiovascular death during the long-term period following the first acute coronary syndrome, and then to determine the long-term survival rate in different risk groups.


METHODS
The prospective five-year observational study included 732 patients with acute coronary syndrome who had survived the hospital period. Employing multivariable Cox's proportional-hazard analysis, the most informative variables were selected, the risk score index was calculated, the risk groups for the prediction of cardiovascular death were identified, long-term survival (4.5 +/- 2.1 years) in different risk groups was determined and internal validation of the model was performed.


RESULTS
During the observational period, 84 patients (11.5%) died due to cardiovascular causes. Cox proportional-hazard models demonstrated that six variables had significant influence on long-term survival during the five-year period after an acute coronary syndrome. These variables were: age [1-5 points], the presence of pathologic Q wave in >2 ECG leads [2 points], Killip class II-IV [2-4 points], left ventricular ejection fraction <35% [2-4 points], proximal stenosis of coronary arteries [2-4 points], absence of myocardial revascularization in the acute period [2 points]. Three strata for risk of cardiovascular death were identified [0-5 points--14.1% patients, 6-10 points--62.6%, >10 points - 23.3%]. The probability of survival within the period of five years was found to be favourable for the majority of patients in the low- and medium-risk groups, while the number of such patients in the high-risk group was significantly lower [97.0% vs. 89.0% vs. 73.0%, P < 0.0000]. The difference in the survival probability was negligible in developmental and validation sets.


CONCLUSIONS
The risk score derived from clinical variables of first acute coronary syndromes permits a reliable determination of risk for cardiovascular death as well as the prediction of long-term survival in different risk groups.
Zaliŭnas
Remigijus
R
Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
Babarskiene
Marija Rŭta
MR
Luksiene
Dalia
D
Slapikien
Birute
B
Vencloviene
Jone
J
Milvidaite
Irena
I
Slapikas
Rimvydas
R
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000503:physiopathology; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors