[Echocardiographic risk score after acute coronary syndrome]. / Score du risque échocardiographique après un syndrome coronaire aigu.

ABSTRACT

AIMS: Identify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores. METHODS: We recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months. RESULTS: The echocardiographic risk score has four variables LV-EF (RR=0.931; 95%CI=0.885-0.979, P<0.01), RV-AF (RR=0.951; 95%CI=0.903-0.999, P<0.05), iMAE-M-strain (RR=1.226; 95%CI=1.081-1.390, P<0.01) and ULCs (RR=1.151; 95%CI=1.081-1.224, P<0.01). Its discrimination capacity (AUC=0.85), greater than that of the clinical risk scores, (GRACE AUC=0.72, TIMI AUC=0.71 and CRUSADE AUC=0.76). DISCUSSION: The risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate. CONCLUSION: The developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.