![]() ![]() In previous reports from FRISC II, troponin T ⩾ 0.03 µg/l 9 or troponin I ⩾ 0.03 µg/l 20 identified patients with increased risk, which therefore were used as cut offs. Troponin T concentration, which was available for 95% of the population, or troponin I, for patients without available troponin T, was used to define the occurrence of increased concentration of biochemical marker of myocardial damage. For body mass index, cholesterol, and fibrinogen no clear cut off level could be identified and the median level was chosen as the cut off. Therefore, for age, 70 years was chosen as the cut off level. In this study patients older than 70 years had a higher incidence of death/MI, whereas in the group between 65–70 years end point rates were similar to those below 65 years (data not shown). On the basis of previous experiences with risk stratification in stable and unstable CAD, variables at baseline that can predict a worse prognosis were selected (table 1 1). As long term dalteparin treatment had no significant effect on 12 months’ outcome, the dalteparin and placebo groups have been combined in the present report. Thereafter, the patients continued long term treatment with dalteparin or placebo. In the non-invasive group coronary angiography or revascularisation was recommended in case of recurrent angina and severe ischaemia during a pre-discharge exercise test or with (new) MI.Īll patients received open label dalteparin for at least five days and always until a scheduled revascularisation procedure. Revascularisation was recommended for all patients with a ⩾ 70% diameter obstruction in any artery supplying a significant proportion of the myocardium. In the early invasive group coronary angiography and if appropriate revascularisation was to be performed within seven days. The patients gave informed, written consent and were randomly assigned to an early invasive or early non-invasive strategy and to short or long term treatment with dalteparin. 17, 18 The objective of this study was to develop a scoring system (the FRISC score) consisting of clinically relevant and accessible factors that may be used to select patients for an early invasive strategy. 13– 16 However, a score focusing on treatment effect would be even more helpful in a clinical setting. Several univariable risk indicators 5, 6, 7, 8, 9, 10, 11, 12 and multivariable risk scores have been used for risk stratification. Thus, a means for selecting patients is needed. ![]() However, not all patients with an episode of unstable CAD will benefit from this treatment, which is both expensive and associated with an inherent procedural risk. 1– 4 Subsequently, treatment recommendations have been changed and revascularisation procedures have increased substantially. In the FRISC (fast revascularisation in instability in coronary disease) II, TACTICS (treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy), and RITA (randomised intervention trial of unstable angina) III trials primary end point rates were reduced by the early invasive strategy. Unstable coronary artery disease (CAD)-unstable angina or non-ST elevation myocardial infarction (MI)-can be treated with an early invasive or a primarily non-invasive regimen. Neither death nor death/MI was reduced in patients with 0–2 risk factors.Ĭonclusion: In unstable CAD, this scoring system based on factors independently associated with an adverse outcome can be used shortly after admission to the hospital for risk stratification and for selection of patients to an early invasive treatment strategy. ![]() In patients with ⩾ 5 of these factors the invasive strategy reduced mortality from 15.4% (20 of 130) to 5.2% (7 of 134) (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.15 to 0.78, p = 0.006). Results: Seven factors, age > 70 years, male sex, diabetes, previous MI, ST depression, and increased concentrations of troponins and markers of inflammation (interleukin 6 or C reactive protein), were associated with an independent increased risk for death or death/MI. From the non-invasive cohort independent variables of death or death/MI were identified. Methods: Patients were randomly assigned to an early invasive or a non-invasive strategy. Main outcome measures: One year rates of mortality and death/myocardial infarction (MI). Patients: 2457 patients with unstable CAD from the FRISC II study. Objective: To develop a scoring system for risk stratification and evaluation of the effect of an early invasive strategy for treatment of unstable coronary artery disease (CAD).ĭesign: Retrospective analysis of a randomised study (FRISC II fast revascularisation in instability in coronary disease). ![]()
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