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Cumulative Assessment Can Indicate Risks Among Unstable Angina Patients

Clinicians can adopt a combination of markers to stratify assessment among patients with non-ST elevation coronary syndromes which, in turn, will identify those among whom the risk of cardiac death or non-fatal myocardial infarction approaches 50 percent.

Researchers from the Department of Cardiology, St Bartholomew's Hospital, London, England, in a prospective cohort study, determined the incremental value of clinical data, troponin T, ST segment monitoring, and heart rate variability, for predicting the outcomes.

Among the cohort of 304 consecutive patients, the clinicians assessed the baseline clinical and electrocardiographic data, along with serial blood samples for troponin T assay. A 48-hour Holter monitoring was performed for ST segment and heart rate variability analysis.

Over the 12 month follow-up period, seven patients died and 21 had had non-fatal myocardial infarction.

The risk of an event among the patients was increased among those with troponin T more than 0.1 microgram/l, T wave inversion on the presenting ECG, Holter ST shift, and a decrease in the standard deviation of five minute mean RR intervals.

Positive predictive values of individual multivariate risk were low. However, analysis of all multivariate risk markers permitted calculation of a cumulative risk score, which increased the positive predictive value to 46.9 percent, while retaining a negative predictive value of 96.9 percent.
Heart 2003 Jan;89(1):36-41. "Cumulative risk assessment in unstable angina: clinical, electrocardiographic, autonomic, and biochemical markers."

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