Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation results from an international trial of 9461 patients

Background-Appropriate treatment policies should include an accurate estima te of a patient's baseline risk. Risk modeling to date has been underutiliz ed in patients with acute coronary syndromes without persistent ST-segment elevation. Methods and Results-We analyzed the relation between baseline characteristi cs and the 30-day incidence of death and the composite of death or myocardi al (re)infarction in 9461 patients with acute coronary syndromes without pe rsistent ST-segment elevation enrolled in the PURSUIT trial [Platelet glyco protein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin (eptifibatide) Therapy], Variables examined included demographics, history, hemodynamic condition, and symptom duration. Risk models were created with multivariable logistic regression and validated by bootstrapping technique s, There was a 3.6% mortality rate and 11.4% infarction rate by 30 days. Mo re than 20 significant predictors for mortality and for the composite end p oint were identified, The most important baseline determinants of death wer e age (adjusted chi(2)=95), heart rate (chi(2)=32), systolic blood pressure (chi(2)=20), ST-segment depression (chi(2)=20), signs of heart failure (ch i(2)=18), and cardiac enzymes (chi(2)=15). Determinants of mortality were g enerally also predictive of death or myocardial (re)infarction. Differences were observed, however, in the relative prognostic importance of predictiv e variables for mortality alone or the composite end point; for example, se x was a more important determinant of the composite end point (chi(2)=21) t han of death alone (chi(2)=10). The accuracy of the prediction of the compo site end point was less than that of mortality (C-index 0.67 versus 0.81). Conclusions-The occurrence of adverse events after presentation with acute coronary syndromes is affected by multiple factors. These factors should be considered in the clinical decision-making process.