Prognostic score for acute coronary syndrome in a private terciary hospital.
BACKGROUND
Available predictive models for acute coronary syndromes (ACS) have limitations as they have been elaborated some years ago or limitations with applicability.


OBJECTIVE
To develop scores for predicting adverse events in 30 days and 6 months in ST-segment elevation and non-ST-segment elevation ACS patients admitted to private tertiary hospital.


METHODS
Prospective cohort of ACS patients admitted between August, 2009 and June, 2012. Our primary composite outcome for both the 30-day and 6-month models was death from any cause, myocardial infarction or re-infarction, cerebrovascular accident (CVA), cardiac arrest and major bleeding. Predicting variables were selected for clinical, laboratory, electrocardiographic and therapeutic data. The final model was obtained with multiple logistic regression and submitted to internal validation with bootstrap analysis.


RESULTS
We considered 760 patients for the development sample, of which 132 had ST-segment elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ± 11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is comprised by five independent variables: age ≥ 70 years, history of cancer, left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml and chemical thrombolysis. In the internal validation, the model showed good discrimination with C-statistic of 0.71. The predictors in the 6-month event final model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I >14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the model had good performance with C-statistic of 0.69.


CONCLUSIONS
We have developed easy to apply scores for predicting 30-day and 6-month adverse events in patients with ST-elevation and non-ST-elevation ACS.
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Edson Renato
ER
Romano
Unidade Coronária, Hospital do Coração, São Paulo, SP, Brasil.
Ieda Maria
IM
Liguori
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Jorge Alcantara
JA
Farran
Unidade Coronária, Hospital do Coração, São Paulo, SP, Brasil.
Rosa Maria Pimentel do
RM
Egito
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Marcelo Luz Pereira
ML
Romano
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Vinícius Avellar
VA
Werneck
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Marco Antonio Oliveira
MA
Barbosa
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Enilton Sergio Tabosa do
ES
Egito
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Alexandre Biasi
AB
Cavalcanti
Unidade de Terapia Intensiva, Hospital do Coração, São Paulo, SP, Brasil.
Leopoldo Soares
LS
Piegas
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D062606:Tertiary Care Centers; D013997:Time Factors; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D003404:Creatinine