Estimating risk of adverse outcomes in the 'average patient' with acute coronary syndromes: comparing a risk model from a clinical trial to that developed in an unselected cohort in the GRACE registry

Résumé fourni par la source

Background: Recently published guidelines state that patients with minimal myocardial injury should be classified as having an MI. In this study, we hypothesized that NSTEMI patients who have Tn+ T or I marker but whose CK-MB levels are undetectable (necrosette infarction) have a similar short-term prognosis as those with undetectable levels of both biochemical markers (UA). We examined the value of a Tn+ marker in the prediction of adverse outcomes. Methods and results: Data from patients with ACS enrolled in the multinational GRACE registry were analyzed. Of the 3479 patients, 49% had UA and 51% had NSTEMI (626 Tn+ patients; 1160 Tn+ and CK-MB+ patients). NSTEMI patients who were positive for both biochemical markers (Tn+ and CK-MB+) had significantly higher rates of hospital mortality or recurrent MI than patients with necrosette infarction (OR 2.3, 95% CI 1.6‐3.2). Patients with necrosette infarction were also more likely to die or have a recurrent MI (OR 3.2, 95% CI 2.2‐4.9) than patients with UA (Figure).

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.