OBJECTIVES: We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome. PATIENTS AND METHOD: Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%). Predictors of cardiac death or infarction within the following six months were analyzed. RESULTS: In the 248 patients in whom ejection fraction was analyzed, 38 major events were recorded. Increased biochemical markers were related to major events (p < 0.05 for all markers). In the final multivariate model, which included clinical, electrocardiographic, serological and systolic function data, ejection fraction was the most powerful predictor of six-month major events: age > 70 years (p = 0,04), insulin-dependent diabetes (p = 0.03), C-reactive protein > 11 mg/l (p = 0.004) and ejection fraction < 50% (p < 0.0001); C-statistic = 0.80. CONCLUSIONS: Apart from the clinical and biochemical profile, analysis of systolic function is advisable for correct risk stratification of patients with non-ST elevation acute coronary syndrome.
OBJECTIVES: We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome. PATIENTS AND METHOD: Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%). Predictors of cardiac death or infarction within the following six months were analyzed. RESULTS: In the 248 patients in whom ejection fraction was analyzed, 38 major events were recorded. Increased biochemical markers were related to major events (p < 0.05 for all markers). In the final multivariate model, which included clinical, electrocardiographic, serological and systolic function data, ejection fraction was the most powerful predictor of six-month major events: age > 70 years (p = 0,04), insulin-dependent diabetes (p = 0.03), C-reactive protein > 11 mg/l (p = 0.004) and ejection fraction < 50% (p < 0.0001); C-statistic = 0.80. CONCLUSIONS: Apart from the clinical and biochemical profile, analysis of systolic function is advisable for correct risk stratification of patients with non-ST elevation acute coronary syndrome.