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Acute coronary syndrome

Prevalence
Clinical features
Differential diagnosis
Investigations
Therapy
Prevention
Prognosis
Investigations

Use the following clinical prediction rule, to rank your patient for risk of dying. a

Sum the following:

  • duration of exercise in minutes
  • minus (5 x maximal net ST-segment deviation during or after exercise, mm)
  • minus (4 x treadmill angina index)

Treadmill angina index

Angina during stress test score
no angina during exercise 0
non-limiting angina 1
stopped due to angina 2

Exercise ECG score

Total score risk of dying
<-10 high
-10 to 4 moderate
5 or more low
 

Why?

Exercise ECG: a clinical prediction rule can help predict mortality

Patient Prognostic Factor Outcome CER NNF+
(95% CI)
suspected coronary artery disease a score <-10
?adjusted 		death
at 4 years 		22%
(4.9% to 39%) 		5
(3 to 20)
  score -10 to 4
?adjusted 		  5.2%
(2.2% to 8.2%) 		19
(12 to 45)
  score 5 or more
?adjusted 		  1.1%
(0.0% to 2.1%) 		95
(48 to 3800)
 

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Authors   CM   Ball , N   Shenker
Reviewer   I K   Jang
CAT Writers   N   Shenker , CJ   Wotton , CM   Ball , RS   Phillips