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Volume 115, Nº 2, August 2020

   

DOI: https://doi.org/10.36660/abc.20190062

ORIGINAL ARTICLE

Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes

Mateus S. Viana

Vitor C. A. Correia

Felipe M. Ferreira

Yasmin F. Lacerda

Gabriela O. Bagano

Leticia L. Fonseca

Lara Q. Kertzman

Milton V. Melo

Marcia M. Noya-Rabelo

Luis C. L. Correia



Figure 1 – C-statistic of cardiovascular death prediction and non-fatal recurrent events, evidencing the accuracy of each score in relation to the type of outcome.





Abstract

Background: Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after na ischemic event results from gravity of insult and ability of the organism to adapt. The distinct nature of those types of events may respond for different prediction properties of clinical and anatomical information regarding type of outcome.

Objective: To identify prognostic properties of clinical and anatomical data in respect of fatal and non-fatal outcomes of patients hospitalized with acute coronary syndromes (ACS).

Methods: Patients consecutively admitted with ACS who underwent coronary angiography were recruited. The SYNTAX score was utilized as an anatomic model and the GRACE score as a clinical model. The predictive capacity of those scores was separately evaluated for prediction of non-fatal ischemic outcomes (infarction and refractory angina) and cardiovascular death during hospitalization. It was considered as significant a p-value <0,05.

Results: EAmong 365 people, cardiovascular death was observed in 4,4% and incidence of non-fatal ischemic outcomes in 11%. For cardiovascular death, SYNTAX and GRACE score presented similar C-statistic of 0,80 (95% IC: 0,70 – 0,92) and 0,89 (95% IC 0,81 – 0,96), respectively – p = 0,19. As for non-fatal ischemic outcomes, the SYNTAX score presented a moderate predictive value (C-statistic = 0,64; 95%IC 0,55 – 0,73), whereas the GRACE score did not presented association with this type of outcome (C-statistic = 0,50; 95%IC 0,40-0,61) – p = 0,027.

Conclusion: Clinical and anatomic models similarly predict cardiovascular death in ACS. However, recurrence of coronary instability is better predicted by anatomic variables than clinical data. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Keywords: Acute Coronary Syndrome/physiopathology; Atherosclerosis; Myocardial Infarction; Mortality; Cardiovascular Diseases/prevention and control; Hospitalization; Prognosis.