A Practical Approach With Outcome for the Prognostic Assessment of Non–ST-Segment Elevation Chest Pain and Normal Troponin - 16/08/11
, Vicent Bodí, MD, PhD a, Julio Núñez, MD a, María José Bosch, MD a, Vicente Bertomeu-González, MD a, Luciano Consuegra, MD a, Enrique Santas, MD a, Cristina Gómez a, Xavier Bosch, MD, PhD b, Francisco Javier Chorro, MD, PhD a, Àngel Llàcer, MD, PhD a
Corresponding author: Tel.: 34-96-386-2658; fax: 34-96-386-2658.Résumé |
Patients with non–ST-elevation chest pain constitute a heterogeneous population. Our aim is to compare the outcome of patients with chest pain, non–ST-segment deviation, and normal troponin, categorized using a risk score, with that of patients with ST depression or troponin increase. A total of 1,449 patients with non–ST-elevation chest pain were evaluated. A validated risk score (using pain characteristics and risk factors) was applied to patients without ST depression or troponin increase. Accordingly, 4 risk categories were defined: group 1, no troponin increase, no ST depression, and risk score <3 points (n = 633); group 2, no troponin increase, no ST depression, but risk score ≥3 points (n = 158); group 3, no troponin increase, ST depression (n = 106); and group 4, troponin increase (n = 552). Median follow-up was 26 months, and the end point was death or myocardial infarction. Group 1 experienced fewer events at 30 days (1.7%, p = 0.0001) and long-term follow-up (9.4%, p = 0.0001) than groups 2 (10.8% and 26%), 3 (6.6% and 30%), and 4 (9.5% and 25%). Kaplan-Meier curves overlapped among groups 2, 3, and 4, whereas group 1 showed a flatter curve (p = 0.0001). Using multivariate analysis, risk group (group 1 vs remaining groups) predicted 30-day (p = 0.0003) and long-term (p = 0.0001) outcome. There were no differences among groups 2, 3, and 4. In conclusion, application of a risk score to patients without troponin increase or ST deviation identified a high-risk group with prognosis similar to that of patients with troponin increase or ST depression and affords a practical classification for the full spectrum of non–ST-elevation chest pain.
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| This work was supported by the Instituto de Salud Carlos III (Spanish Public Health System, Spain) under the grant RECAVA-FIS and by the Fundación Española del Corazón (Sociedad Española de Cardiología, Spain) under the grant “Beca para Investigación Clínica y Básica en Cardiología 2005”, Madrid, Spain. |
Vol 99 - N° 6
P. 797-801 - mars 2007 Retour au numéro
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