Risk Stratification and Therapeutic Decision Making in Acute Coronary Syndromes
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چکیده
with an acute STEMI, the optimal treatment is usually clear-proceed to PCI immediately. The situation is less clear with unstable angina and NSTEMI's, a heterogeneous group of acute coronary syndromes with a wide spectrum of risk for death and cardiac ischemic events. Prognostication of risk in these patients is critical as it can dictate optimal therapy and location of treatment (outpatient vs. hospital ward vs. CCU). Using the database of the TIMI 11B and ESSENCE trials (both phase III, international, randomized, double-blind trials which compared treatment with unfractionated heparin vs. enoxaparin in patients with UA/NSTEMI), twelve variables at presentation were examined with respect to a composite end-point of all-cause mortality, new or recurrent MI, or severe recurrent ischemia prompting urgent revascularization through 14 days. Seven of the 12 variables were statistically significant and formed the final set of predictor variables: 1) age greater than 65; 2) greater than 3 risk factors for CAD (family history, HTN, hyperlipidemia, DM, current smoker); 3) prior coronary stenosis of greater than 50%; 4) ST-segment deviation on EKG at presentation; 5) at least 2 anginal events in the prior 24 hours; 6) use of aspirin in the prior 7 days; 7) elevated serum cardiac markers. Event rates increased significantly as the TIMI risk score increased (0/1: 4. Three validation cohorts were used to validate these findings.
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تاریخ انتشار 2009