Prognosis

Mortality

Overall mortality for the non-ST-elevation acute coronary syndrome (NSTE-ACS) patient population is 4.8% over a 6-month period.[130]

After 6 months, NSTE-ACS population mortality rates exceed those of the ST-elevated myocardial infarction population.[131]

At 12 months, rates of adverse cardiovascular events (recurrent ischaemia, myocardial infarction and death) are as high as 10% in NSTE-ACS patients, possibly reflecting diffuse active atherosclerotic disease beyond the initial culprit lesion.[2][132]

Prognostic factors

Adverse prognostic markers in patients with unstable angina include rest pain, presence of comorbidity (such as diabetes mellitus, hypertension, dyslipidaemia, renal failure), signs of left ventricular failure, ST depression on ECG, raised biomarkers, and angiographic findings of left main disease and multi-vessel disease.[133]

Short-term risk of death or non-fatal myocardial infarction in patients with unstable angina is related to a number of factors:

  • A history of accelerated tempo of ischaemic symptoms in the preceding 48 hours

  • Prolonged ongoing rest pain >20 minutes

  • Pulmonary oedema or new mitral regurgitation

  • Age >75 years

  • ECG findings of ST-T changes, new bundle branch block, sustained ventricular tachycardia.

Risk assessment models

Risk assessment models integrating prognostic markers have been validated as predictor of outcome at 14 days, 30 days, and up to 6 months.[134][135][136] [ GRACE Score for Acute Coronary Syndrome Prognosis Opens in new window ]

These models for NSTE-ACS short-term outcomes have been shown to maintain predictive value for death or myocardial infarction at 1 year.[137]

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