Solomon et al reported a simple model for evaluating a patient with unstable angina. This can help to identify a patient who may benefit from more aggressive management. The authors are from Brigham and Women's Hospital, University of California at San Francisco and University of Vermont.
Patient selection: unstable angina
Outcome: 1-year death or AMI
Parameters:
(1) ST segment depression in mV (in at least 2 contiguous leads)
(2) accelerated angina in prior 2 months
(3) serum CK-MB in IU/mL
(4) age in years
Parameter
Finding
Points
ST segment depression
none or < 0.1 mV
0
>= 0.1 mV
2
accelerated angina
no
0
yes
2
CK-MB
<= 5 IU/mL
0
> 5 IU/mL
1
age
<= 50 years
0
51 to 59 years
1
60 to 69 years
2
>= 70 years
5
where:
• The CK-MB test has been largely replaced by serum troponin testing.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
Score
Risk
1-Year Outcome (Conservative Arm)
0 to 2
very low
6%
3 or 4
low
9%
5 or 6
moderate
13%
7 or 8
high
24%
9 or 10
very high
28%
Performance:
• The area under the ROC curve is 0.66.
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