Emergency medicine journal : EMJ · 2011
Comparison of two clinical scoring systems in risk stratification of non-ST elevation acute coronary syndrome patients in predicting 30-day outcomes.
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Rawlings Charlotte, Oglesby Kieran, Turner Jim, Sen Aruni
Аннотация
BACKGROUND: Non-ST elevation acute coronary syndromes (NSTEACS) confer a broad range of risk of adverse outcomes following presentation to an emergency department. This study compares the Thrombolysis in Myocardial Infarction (TIMI) risk scoring system with the used but untested, Cheshire, Merseyside and North Wales Cardiac Network (CMNW) NSTEACS risk stratification system in predicting the adverse outcomes of re-admission to hospital with either a NSTEACS or death at 30 days post presentation.
METHOD: Once a diagnosis of NSTEACS was made, patients were risk scored, then case notes were retrieved 30 days later. Primary adverse outcome of death and secondary adverse outcome of NSTEACS at 30 days was analysed using a ROC curve.
RESULTS: 104 patients were included in the study diagnosed as having NSTEACS. Of these patients, 11 (11%) were initially diagnosed as having unstable angina (UA) (troponin I negative, <0.07), 43 (41%) non-ST elevation myocardial infarction Group 1 (troponin I 0.07-0.49) and 50 (48%) had non-ST elevation myocardial infarction Group 2 (troponin I ≥0.50). For death at 30 days, the CMNW risk c-statistic is 0.845 (95% CI 0.728 to 0.962, asymptotic significance 0.02) and TIMI 0.670 (CI 0.493 to 0.847, asymptotic significance 0.25). NSTEACS at 30 days (including NSTEMI and UA), the CMNW risk c-statistic is 0.466 (95% CI 0.345 to 0.586, asymptotic significance 0.616), TIMI 0.418 (CI 0.281 to 0.555, asymptotic significance 0.231).
CONCLUSIONS: The CMNW score categorised more patients as higher risk, who suffered death at 30 days than the TIMI score.
METHOD: Once a diagnosis of NSTEACS was made, patients were risk scored, then case notes were retrieved 30 days later. Primary adverse outcome of death and secondary adverse outcome of NSTEACS at 30 days was analysed using a ROC curve.
RESULTS: 104 patients were included in the study diagnosed as having NSTEACS. Of these patients, 11 (11%) were initially diagnosed as having unstable angina (UA) (troponin I negative, <0.07), 43 (41%) non-ST elevation myocardial infarction Group 1 (troponin I 0.07-0.49) and 50 (48%) had non-ST elevation myocardial infarction Group 2 (troponin I ≥0.50). For death at 30 days, the CMNW risk c-statistic is 0.845 (95% CI 0.728 to 0.962, asymptotic significance 0.02) and TIMI 0.670 (CI 0.493 to 0.847, asymptotic significance 0.25). NSTEACS at 30 days (including NSTEMI and UA), the CMNW risk c-statistic is 0.466 (95% CI 0.345 to 0.586, asymptotic significance 0.616), TIMI 0.418 (CI 0.281 to 0.555, asymptotic significance 0.231).
CONCLUSIONS: The CMNW score categorised more patients as higher risk, who suffered death at 30 days than the TIMI score.