Prognostic Variables in USAP/NSTEMI patients who treated Invasively

Background: Unstable angina (USAP)/Non?ST-segment elevation myocardial infarction (NSTEMI) patients compose a heterogeneous group, some of which need invasive treatment and followed up in coronary intensive care units due to high MI and mortality risk while some others have good-prognosis responding well to appropriate treatments. Therefore risk stratification in USAP/NSTEMI provides an estimate of a patient?s prognosis and optimizes clinical choices. At present most of the acute coronary syndrome patients are treated invasively. However, at the mean time there is no risk estimation protocol in patients with USAP/NSTEMI who had solely treated invasively. This trial aims to develop a clinically applicable risk score system for USAP/NSTEMI patients who had received invasive treatment.Methods: One hundred ninety-two USAP/NSTEMI patients (131 male and 61 female) who had received invasive treatment were included in the study. Variables of the patients who died during 37±21 months of follow-up period or had major adverse cardiovascular events (MACE) were compared with the patients who had survived and were free of MACE.Results: Mean age, Killip score, cardiac enzyme levels on admission were significantly higher whereas EF was lower in patients who died during follow up. Furthermore, history of DM, congestive heart failure, use of aspirin before admission, atrial fibrillation, ST and T wave shift were significantly lower in survivors. Correlation analysis revealed that age, history of DM, HT, and congestive heart failure, atrial fibrillation, ST and T wave shift, heart rate, CK-MB, creatinine, HDL, peak CK-MB, use of aspirin before admission, use of in hospital statin and nitrates, multivessel disease, >2 chest pain episodes in the last 24 hours were significantly correlated with mortality. HDL and AF were independent predictors of mortality in logistic regression analysis. A new risk estimation (RE) formula was developed by adding 2 points for AF and 1 point for low HDL < 40 mg/dl. A RE point higher than 3 could predict mortality with 84% sensitivity and 61% specificity. When the same analysis is made by TIMI risk scoring mortality rate could be predicted with 80% sensitivity and 47 %specificity.Conclusions: Addition of quickly applicable variables such as AF and HDL to the widely used TIMI and GRACE risk scoring systems, a better risk prediction can be obtainedKeywords: USAP/NSTEMI, Risk Scoring, AF, HDL.