title: Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  To investigate comorbid conditions with prognostic influence in non-ST-segment elevation acute coronary syndrome (NSTEACS).
  
  
  METHODS
  The study group consisted of a derivation cohort of 1017 patients (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 patients (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and coronary artery disease-specific index, were recorded. The main outcome was one-year mortality.
  
  
  RESULTS
  During follow-up, 103 patients died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia (HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6), and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P = .0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease-specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P = .001), without significant differences among the 3 indices. In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P = .001).
  
  
  CONCLUSIONS
  Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of patients with comorbid conditions merits further investigation.
authors.affiliation: Cardiology Department, University Clinic Hospital, Medicine Department, University of València, Blasco Ibáñez 17, 46010 València, Spain. sanchis_juafor@gva.es
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Ana
authors.initials: A
authors.lastname: García-Alvarez
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: Joan
authors.initials: J
authors.lastname: Sala
authors.forename: Oscar
authors.initials: O
authors.lastname: Bielsa
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology