Risk stratification for revascularisation in acute ischaemic syndromes

Dr Saw as Sophocles Constantinides “Risk stratification for revascularisation in acute ischaemic coronary syndromes” Abstract: Aim o f study: PHASE I: To identify those clinical and simple anatomical variables that could predict early (30 days), medium (6 month) and late (1 year) mortality following Percutaneous Coronary Intervention (PCI) for non ST segment elevation Acute Coronary Syndromes (NSTEACS). To compare outcomes in a contemporary group undergoing Coronary artery Bypass Surgery (CABG) and to examine which clinical variables are related to early mortality. PHASE II: To develop a PCI risk score and apply it to the same database. To then apply the risk score to a separate cohort o f patients for validation. Methods: Data from 630 consecutive patients undergoing PCI for NSTEACS between January 1999 and December 2000 were analysed. Data ffom 522 patients who underwent CABG were also analysed for similar variables and outcomes were noted. The derived 8 variable PCI risk score was applied on the following 500 consecutive patients undergoing PCI for NSTEACS between January 2001 and August 2002. Results: Age, partial revascularisation, peripheral vascular disease, diabetes mellitus and left ventricular impairment were found to be significant predictors of mortality following PCI for ACS. A ‘risk-score’ model including age, LV impairment, multi-vessel disease, diabetes, renal impairment, peripheral vascular disease and female sex was then tested on the same cohort and found to be good in predicting death following PCI. In the surgical study group higher rates o f mortality were found with age, clinical features o f heart failure, LV impairment, chronic airways disease and cerebrovascular disease. The derived PCI risk score was found on validation to be a good predictive tool for mortality. Conclusion: Individualisation o f risk stratification for patients undergoing revascularisation for acute coronary syndromes is not only possible but also simple using easily available clinical information by the bedside. The use o f such a risk score should be considered when patients are being evaluated for such procedures. Aim o f study: PHASE I: To identify those clinical and simple anatomical variables that could predict early (30 days), medium (6 month) and late (1 year) mortality following Percutaneous Coronary Intervention (PCI) for non ST segment elevation Acute Coronary Syndromes (NSTEACS). To compare outcomes in a contemporary group undergoing Coronary artery Bypass Surgery (CABG) and to examine which clinical variables are related to early mortality. PHASE II: To develop a PCI risk score and apply it to the same database. To then apply the risk score to a separate cohort o f patients for validation. Methods: Data from 630 consecutive patients undergoing PCI for NSTEACS between January 1999 and December 2000 were analysed. Data ffom 522 patients who underwent CABG were also analysed for similar variables and outcomes were noted. The derived 8 variable PCI risk score was applied on the following 500 consecutive patients undergoing PCI for NSTEACS between January 2001 and August 2002. Results: Age, partial revascularisation, peripheral vascular disease, diabetes mellitus and left ventricular impairment were found to be significant predictors of mortality following PCI for ACS. A ‘risk-score’ model including age, LV impairment, multi-vessel disease, diabetes, renal impairment, peripheral vascular disease and female sex was then tested on the same cohort and found to be good in predicting death following PCI. In the surgical study group higher rates o f mortality were found with age, clinical features o f heart failure, LV impairment, chronic airways disease and cerebrovascular disease. The derived PCI risk score was found on validation to be a good predictive tool for mortality. Conclusion: Individualisation o f risk stratification for patients undergoing revascularisation for acute coronary syndromes is not only possible but also simple using easily available clinical information by the bedside. The use o f such a risk score should be considered when patients are being evaluated for such procedures.