Cumulative risk assessment in unstable angina: clinical, electrocardiographic, autonomic, and biochemical markers
S Kennon1, C P Price, P G Mills
1Department of Cardiology, Barts and the London NHS Trust, London, UK. srok@dircon.co.uk
Insights
A cumulative risk score using clinical data, troponin T, and ECG monitoring effectively predicts major adverse cardiac events in non-ST elevation acute coronary syndromes. This approach identifies high-risk patients for improved outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Non-ST elevation acute coronary syndromes (NSTE-ACS) require accurate risk stratification.
- Predicting cardiac death and myocardial infarction is crucial for timely intervention.
Purpose of the Study:
- To evaluate the added value of clinical data, troponin T, ST segment monitoring, and heart rate variability in predicting outcomes for NSTE-ACS patients.
- To develop a cumulative risk score for enhanced risk stratification.
Main Methods:
- Prospective cohort study of 304 NSTE-ACS patients.
- Collected baseline clinical and ECG data, serial troponin T levels, and 48-hour Holter monitoring for ST shifts and heart rate variability.
- Assessed cardiac death and non-fatal myocardial infarction over 12 months.
Main Results:
- Troponin T > 0.1 microg/l, T wave inversion, Holter ST shift, and decreased heart rate variability were associated with increased event risk.
- Individual risk markers had low predictive values.
- A cumulative risk score achieved 46.9% positive predictive value and 96.9% negative predictive value.
Conclusions:
- A cumulative risk stratification approach is effective in identifying NSTE-ACS patients at high risk.
- This method identifies a subgroup with nearly 50% risk of major adverse cardiac events.
Objectives:
To determine the incremental value of clinical data, troponin T, ST segment monitoring, and heart rate variability for predicting outcome in patients with non-ST elevation acute coronary syndromes.
Methods:
Prospective cohort study of 304 consecutive patients. Baseline clinical and electrocardiographic data were recorded, serial blood samples were obtained for troponin T assay, and 48 hour Holter monitoring was performed for ST segment and heart rate variability analysis. End points were cardiac death and non-fatal myocardial infarction during 12 months' follow up.
Results:
After 12 months, 7 patients had died and 21 had had non-fatal myocardial infarction. The risk of an event was increased by troponin T > 0.1 microg/l, T wave inversion on the presenting ECG, Holter ST shift, and a decrease in the standard deviation of 5 minute mean RR intervals. Positive predictive values of individual multivariate risk were low; however, analysis of all multivariate risk markers permitted calculation of a cumulative risk score, which increased the positive predictive value to 46.9% while retaining a negative predictive value of 96.9%.
Conclusion:
A cumulative approach to risk stratification in non-ST elevation coronary syndromes successfully identifies a group in whom the risk of cardiac death or non-fatal myocardial infarction approaches 50%.
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