| COMPARISON OF PROGNOSTIC VALUE OF CLINICAL RISK SCORE AND TIMI FLOW GRADE ON THE OUTCOME OF ACUTE CORONARY SYNDROMEObjective: To compare the prognostic value of clinical risk score and TIMI flow grade alone or combined on outcomes of acute coronary syndrome.Methods: To evaluate the outcomes of the patients with acute coronary syndrome based on clinical risk score, TIMI flow grade or combined risk score including clinical risk score and TIMI flow grade, the patients who were hospitalized and had coronary angiography or percutaneous intervention in our hospital from December, 2004 to June, 2006 were enrolled. The primary endpoints of this study included cardiac death and non-cardiac death. The secondary endpoints included non-fatal stroke, reinfarction, heart failure and recurrent angina. Receiver Operating Characteristic Curve (ROC) constructed by using total events and clinical risk score, TIMI flow grade or combined risk score was used to compare the prognostic values.Result: 206 patients with the mean age 67.57±9.88 years were enrolled in this study including 11 patients who lost in follow-up. Averaged follow-up time was 11.41±5.33 months, and 135 patients (69.2%) were male. During the follow up period, there are 8 patients reached the primary endpoints, and 17 patients reached the secondary end-points. The prognostic value for the total events expressed as the area under the curve (AUC). The AUC of the clinical risks core was 0.67(95%CI=0.557~0.786), P=0.006; the AUC of the TIMI flow grade was 0.68 (95%CI=0.595~0.765), P=0.004; the AUC of the combined risk score was 0.73(95%CI=0.691~ 0.815), P<0.001; In pairewise comparison, there were no significant differences among clinical risk score, TIMI flow grade and combined risk score, the exact P values of clinical risk score vs TIMI flow grade, of clinical risk score vs combined risk score and of TIMI flow grade vs combined risk score were 0.918, 0.215 and 0.428, respectively. Similarly, no significant differences were found in pairewise comparisons of the prognostic values of clinical risk score, TIMI flow grade and combined risk score on the primary end point and the secondary end point.Conclusions: The result from this study suggests that the efficacy of predicting the total events based on clinical risk score, TIMI flow grade and combined risk score is similar. The combined risk score could be used to predict not only the total events but also the primary endpoints or the secondary endpoints. CLINICAL OUTCOME UTILIZING REVASCULARIZATION AND OPTIMAL DRUG EVALUATION IN MEN WITH ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATIONObjective: To evaluate the influence of revascularization and optimal drug on long term outcomes of men with acute coronary syndromes without ST segment elevation.Methods: Divided into two groups (revascularization and optimal drug group), the male patients with acute coronary syndromes without ST-segment elevation who were hospitalized in our hospital were followed-up. Exclusion criterion: the patients with coronary stenosis less than 50%, myocardial bridge and with sever renal insufficiency (serum creatinine>445μmmol/L) were excluded. The primary endpoint of this study included cardiac and non-cardiac death. The secondary endpoint included non-fatal stroke, reinfarction, heart failure and recurrent angina. Deadline of follow-up was November 30, 2006, with an averaged follow-up time was 30.08±24.50 (5-99) months.Results: 323 male patients (revascularization group vs optimal drug group: 199 vs124) with acute coronary syndrome without ST-segment elevation were enrolled, including 58 patients who had been lost to follow-up (revascularization group 39 patients, optimal drug group 19 patients).10 patients reached the primary endpoints in the revascularization group comparing with 18 patients in the optimal drug group, Log rank=9.713,P=0.002,HR=0.3145(95%CI=0.1346~0.6337); of whom, there were 8(5%) vs 15(14.6%) patients, respectively, belonged to cardiac death,Log rank= 8.715,P=0.003,HR=0.2981 (95%CI=0.1171~ 0.6490). The mean survival time was 89.04 months (95%CI=83.22~94.87) vs 75.98 months (95%CI=65.64 ~85.33), respectively. There were 20 patients in the revascularization group and 15 patients in the optimal drug group reached the secondary end points, P=0.407. Age, HDL, serum creatinine were the dominant influence factors of death in Cox regression analysis.Conclusion: Male patients with acute coronary syndromes without ST-segment elevation can benefit from revascularization; especially, the patients older than 65 years, with decreased high density lipoprotein and with normal renal function would benefit more from revascularization. Mean survival time could be prolonged about 14 months. |
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