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Short- and Long-Term Risk Stratification in Acute Coronary Syndromes

The Added Value of Quantitative ST-Segment Depression and Multiple Biomarkers

Cynthia M. Westerhout, MSc^_*,,_*, Yuling Fu, MD^_*, Michael S. Lauer, MD, FACC, Stefan James, MD, PhD, Paul W. Armstrong, MD, FACC^_*, Eyad Al-Hattab, MD, Robert M. Califf, MD, FACC^||,2, Maarten L. Simoons, MD, FACC, Lars Wallentin, MD, PhD, FACC^,1, Eric Boersma, PhD on behalf of the GUSTO-IV ACS Trial Investigators

^_* University of Alberta, Edmonton, Canada
Erasmus Medical Center, Rotterdam, the Netherlands
Cleveland Clinic Foundation, Cleveland, Ohio
University of Uppsala, Uppsala, Sweden
^|| Duke Clinical Research Institute, Durham, North Carolina

View larger version (14K): [in a new window]   Figure 1 Relative contribution of significant, independent factors to the prediction of 30-day death, 30-day death/myocardial infarction (MI), and 1-year death. Creat. Cl. = creatinine clearance; CRP = C-reactive protein; Curr. Smok. = current smoker; HR = heart rate; Hx Ang = history of angina pectoris; Hx CABG = history of coronary artery bypass graft; Hx CHF = history of congestive heart failure; Hx MI = history of MI; Hx lipidRx = history of hyperlipidemic therapy; Hx PCI = history of percutaneous coronary intervention; Hx strk = history of stroke; NT-proBNP = N-terminal pro-brain natriuretic peptide; ST-dep = ST-segment depression; TnT = troponin T; Wgt = weight.

View larger version (7K): [in a new window]   Figure 2 Calibration of risk models: (A) 30-day death; (B) 30-day death/myocardial infarction (MI); (C) 1-year death. Dots represent deciles of predicted risk; the solid line represents perfect calibration.

View larger version (11K): [in a new window]   Figure 3 Increase in adjusted C-index as biomarkers and quantitative ST-segment depression are added to the models predicting (A) 30-day (open dots) and 1-year death (closed dots) and (B) 30-day death or MI (closed diamonds). Abbreviations as in Figure 1.

View larger version (18K): [in a new window]   Figure 4 Simplified risk score and nomogram to estimate risk of mortality at 30 days (open dots) and 1 year (closed dots) and of death or myocardial infarction (MI) at 30 days (solid x’s).