title: Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome.
abstract: Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.
authors.affiliation: Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Lown
authors.forename: Theresa
authors.initials: T
authors.lastname: Munyombwe
authors.forename: Wendy
authors.initials: W
authors.lastname: Harrison
authors.forename: Robert M
authors.initials: RM
authors.lastname: West
authors.forename: Christiana A
authors.initials: CA
authors.lastname: Hall
authors.forename: Christine
authors.initials: C
authors.lastname: Morrell
authors.forename: Beryl M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sapsford
authors.forename: Niamh
authors.initials: N
authors.lastname: Kilcullen
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Pepper
authors.forename: Phil D
authors.initials: PD
authors.lastname: Batin
authors.forename: Alistair S
authors.initials: AS
authors.lastname: Hall
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology