Predictive prognosis value of echocardiographic risk score after acute coronary syndromes - 09/01/21
Résumé |
Background |
The stratification of the risk of a major cardiovascular event after an acute coronary syndrome by Doppler echocardiography provides prognostic support to the different clinical models and allows a non-invasive evaluation of the risk, independent of comorbidities. The echoscore provides a better definition of the categories of high-risk and intermediate patients for whom a more aggressive approach improves outcomes.
Purpose |
The aim of our study is to identify the echocardiographic parameters predictive of major cardiovascular events (death, reinfarction and rehospitalisation) in the acute phase and after six months of follow-up after acute coronary syndrome.
Methods |
We recruited 302 patients (215 men, age 63±12 years) who had been admitted for ACS (151 [50%] with STEMI, 108 [35.8%] with NSTEMI and 43 [14.2%] with unstable angina). Patients were assessed by resting echocardiography. A follow-up of six months of all patients.
Results |
The echocardiographic variables significant after a binary logistic regression that are independent predictors of hard event: LVEF (RR=0.931; 95% CI=0.885–0.979, P<0.01), RV-FA (RR=0.951; 95% CI=0.903–0.999, P<0.05), iMAE-M-strain (RR=1.226; 95% CI=1.081–1.390, P<0.01) and ULCs (RR=1.151; 95% CI=1.081–1.224, P<0.01). The echocardiographic model is the sum of scores of the 4 variables selected (from 4 points for low risk with a probability for major cardiovascular event 3.4%, up to 16 points for high-risk with a probability of 15.1%). This score has good prognosis accuracy (AUROC=0.85) and it retains good (AUCROC=0.80) when testing on the validation cohort.
Conclusion |
The developed echocardiographic model could prove very useful in the decision-making process and optimisation of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.
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Vol 13 - N° 1
P. 61 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.