Details

Autor(en) / Beteiligte

• Lown, Mark T., BEng, PhD, MBBS
• Munyombwe, Theresa, MSc
• Harrison, Wendy, MSc
• West, Robert M., BSc, MSc, DPhil
• Hall, Christiana A., MBChB
• Morrell, Christine, RGN, SCM
• Jackson, Beryl M., RGN, SCM
• Sapsford, Robert J., MBBS, BSc, MD
• Kilcullen, Niamh, MBBCh, MD
• Pepper, Christopher B., BSc, MD
• Batin, Phil D., BSc, MBChB, DM
• Hall, Alistair S., MBBCh, PhD
• Gale, Chris P., BSc, MBBS, PhD, MEd

Titel

Association of Frontal QRS-T Angle–Age Risk Score on Admission Electrocardiogram With Mortality in Patients Admitted With an Acute Coronary Syndrome

Ist Teil von

• The American journal of cardiology, 2012-02, Vol.109 (3), p.307-313

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle–age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non–ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.