OBJECTIVE
To investigate comorbid conditions with prognostic influence in non–ST-segment elevation
acute coronary syndrome (NSTEACS).
PATIENTS AND METHODS
The study group consisted of a derivation cohort of 1017 patients (admitted from October
1, 2002, through October 1, 2008) and an external validation cohort of 652 patients
(admitted from February 1, 2006, through September 30, 2009). Comorbid conditions,
including risk factors and components of the Charlson comorbidity index (ChCI) and
coronary artery disease–specific index, were recorded. The main outcome was one-year
mortality.
RESULTS
During follow-up, 103 patients died. After adjusting for variables associated with
NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe
or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia
(HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6),
and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was
developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8;
P=.0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease–specific
index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively,
in discriminative ability (P=.001), without significant differences among the 3 indices. In patients with comorbid
conditions, the highest risk period was in the first weeks after NSTEACS. The strength
of the association between SCI and mortality rate was similar in the external validation
cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P=.001).
CONCLUSION
Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and
previous myocardial infarction are the comorbid conditions that predict mortality
in NSTEACS. A simple index using these variables proved to be as accurate as the more
complex comorbidity indices for risk stratification. In-hospital management of patients
with comorbid conditions merits further investigation.
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Article Info
Footnotes
This work was supported in part by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (FEDER), Red HERACLES RD06/0009 . Drs Sanchis, Bosch, and Heras were also supported by a grant ( FIS PI080634 ; Instituto de Salud Carlos III, Madrid, Spain ).
Drs García-Alvarez, Regueiro, Bosch, and Heras received an unrestricted grant from GlaxoSmithKline for assembling the validation cohort.
An earlier version of this article appeared Online First.
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© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
