Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2003;56:857-64 - Vol. 56 Num.09

Prognostic Markers of Non-ST Elevation Acute Coronary Syndromes

Vicent Bodí a, Juan Sanchis a, Àngel Llácer a, Lorenzo Fácila a, Julio Núñez a, Mauricio Pellicer a, Vicente Bertomeu a, Vicente Ruiz a, Francisco J Chorro a

a Servicio de Cardiología. Hospital Clínic i Universitari. Universitat de València. València. España.

Keywords

Unstable angina. Infarction. Prognosis. Systole. Troponin. C-reactive protein.

Abstract

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.

1885-5857/© 2003 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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