Patient stratification and its predictive value for cardiac events.

Abstract

In the GUSTO IIb trial, the combined rate of death and non-fatal myocardial infarction for patients with unstable coronary syndromes was nearly 10% despite therapy with aspirin, heparin or hirudin, beta-blockers, nitrates and, in selective patients, calcium channel blockers. Thus, therapy of such patients can be improved. Follow-up and therapy can be optimized if patients can be stratified by risk according to characteristics on admission. In the GUSTO IIb trial, age, low systolic and diastolic blood pressure and high heart rate were important determining factors of outcome in both ST- and non-ST elevation patients. In the TIMI IIIB study, rest pain within the first 48 h in patients with unstable angina or post-myocardial infarction was associated with a higher incidence of cardiac events. In addition, mortality was influenced by the number of leads with ST changes and the extent of ST deflection. Additional data from GUSTO IIa showed that elevated troponin-T levels were associated with a higher incidence of mortality. A similar relationship was shown with troponin-I in the TIMI study. The FRISC trial demonstrated that patients with elevated troponin-T levels treated with a low-molecular-weight heparin had comparable death/myocardial infarction rates to patients without elevated troponin-T levels.