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Published on: January 28, 2020
[Prognostic markers of non-ST elevation acute coronary syndromes]
Vicent Bodí1, Juan Sanchis, Angel Llácer
1Servicio de Cardiología. Hospital Clínic i Universitari. Universitat de València. València. España. vicentbodi@hotmail.com
Insights
Echocardiography-derived systolic function, specifically ejection fraction, provides crucial independent information for predicting major adverse events after non-ST elevation acute coronary syndrome, beyond clinical and biochemical markers.
Area of Science:
- Cardiology
- Echocardiography
- Biomarkers
Context:
- Non-ST elevation acute coronary syndrome (NSTE-ACS) poses significant risks for major adverse cardiac events.
- Accurate risk stratification is essential for optimal patient management.
- Current risk assessment often relies on clinical, electrocardiographic, and biochemical markers.
Purpose:
- To determine if echocardiography-derived systolic function adds independent predictive value to established markers for six-month major events in NSTE-ACS patients.
- To compare the predictive power of ejection fraction against biochemical markers.
Summary:
- A prospective study analyzed 515 NSTE-ACS patients, with ejection fraction assessed in 248.
- Increased biochemical markers correlated with major events.
- In a multivariate model, ejection fraction < 50% emerged as the strongest predictor of six-month cardiac death or infarction, outperforming age, diabetes, and C-reactive protein.
Impact:
- Echocardiographic assessment of systolic function is a valuable, independent predictor of adverse outcomes in NSTE-ACS.
- Integrating systolic function analysis into risk stratification models can improve patient selection for intensified therapy or closer monitoring.
- This finding supports enhanced risk stratification beyond traditional clinical and serological assessments.
Objectives:
We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome.
Patients And Method:
Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%). Predictors of cardiac death or infarction within the following six months were analyzed.
Results:
In the 248 patients in whom ejection fraction was analyzed, 38 major events were recorded. Increased biochemical markers were related to major events (p < 0.05 for all markers). In the final multivariate model, which included clinical, electrocardiographic, serological and systolic function data, ejection fraction was the most powerful predictor of six-month major events: age > 70 years (p = 0,04), insulin-dependent diabetes (p = 0.03), C-reactive protein > 11 mg/l (p = 0.004) and ejection fraction < 50% (p < 0.0001); C-statistic = 0.80.
Conclusions:
Apart from the clinical and biochemical profile, analysis of systolic function is advisable for correct risk stratification of patients with non-ST elevation acute coronary syndrome.
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