ABC | Volume 115, Nº2, August 2020

Original Article Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes Mateus S. Viana, 1 V itor C. A. Correia, 1 Felipe M. Ferreira, 1 Yasmin F. Lacerda, 1 Gabriela O. Bagano, 1 Leticia L. Fonseca, 1 Lara Q. Kertzman, 1 Milton V. Melo, 1 Marcia M. Noya-Rabelo, 2 L uis C L Correia 1 Escola Bahiana de Medicina e Saúde Pública, 1 Salvador, BA - Brazil Hospital São Rafael, 2 Salvador, BA – Brazil Mailing Addresss: Luis Correia • Escola Bahiana de Medicina e Saúde Pública – Av. Princesa Leopoldina, 19/402. Postal Code 40050-420, Salvador, BA – Brazil E-mail: lccorreia@cardiol.br Manuscript received January 28, 2019, revised manuscript June 20, 2019, accepted July 17, 2019 DOI: https://doi.org/10.36660/abc.20190062 Abstract Background: Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after an 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. Introduction Multivariate models have been validated as prognostic tools in acute coronary syndromes (ACS), consisting of clinical data, 1 anatomical data 2 or a combination of the two. 3-6 These models have recognized predictive value for recurrent events, but it is not clear whether the prognostic value varies depending on the type of outcome. Recurrent non-fatal ischemic events represent the phenomenon of atherosclerotic plaque instability, while death after an ischemic event results from the severity of the insult and the resistance of the organism. The different pathophysiological nature of these types of events can cause clinical and anatomical data to have different prognostic capacities depending on the type of outcome. If this is true, the generalization of the prognostic value regarding “cardiovascular outcomes” would be compromised, making it necessary to individualize the prediction of each model for the type of outcome. This work aims to evaluate and compare the prognostic value of clinical and anatomical data in relation to fatal and non-fatal outcomes in patients with ACS. Thus, a hospital cohort with patients admitted under these conditions was performed, the GRACE score chosen as the representative of the prediction for clinical data and the SYNTAX score used as a predictor based on anatomy. Metodology Study Population Individuals consecutively admitted to the Intensive Cardiovascular Unit of a tertiary hospital between July 2007 and September 2014, with a diagnosis of ACS, were selected. The inclusion criterion was defined by typical or equivalent precordial discomfort and at rest in the last 48 hours, associated 219