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FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease
  1. B Lagerqvist1,
  2. E Diderholm1,
  3. B Lindahl1,
  4. S Husted2,
  5. F Kontny3,
  6. E Ståhle4,
  7. E Swahn5,
  8. P Venge6,
  9. A Siegbahn6,
  10. L Wallentin1
  1. 1Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden
  2. 2Department of Cardiology, University Hospital, Aarhus, Denmark
  3. 3Department of Cardiology, Ullevål University Hospital, Oslo, Norway
  4. 4Department of Thoracic Surgery, University Hospital, Uppsala, Sweden
  5. 5Department of Cardiology, University Hospital, Linköping, Sweden
  6. 6Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
  1. Correspondence to:
    Dr Bo Lagerqvist
    Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden; bo.lagerqvistucr.uas.lul.se

Abstract

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).

Design: Retrospective analysis of a randomised study (FRISC II; fast revascularisation in instability in coronary disease).

Setting: 58 Scandinavian hospitals.

Patients: 2457 patients with unstable CAD from the FRISC II study.

Main outcome measures: One year rates of mortality and death/myocardial infarction (MI).

Methods: Patients were randomly assigned to an early invasive or a non-invasive strategy. From the non-invasive cohort independent variables of death or death/MI were identified.

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. 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). Death/MI was also reduced in patients with 3–4 factors from 15.7% (80 of 511) to 10.8% (58 of 538) (RR 0.69, 95% CI 0.50 to 0.94, p  =  0.02). Neither death nor death/MI was reduced in patients with 0–2 risk factors.

Conclusion: 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.

  • CAD, coronary artery disease
  • CRP, C reactive protein
  • FRISC, fast revascularisation in instability in coronary disease
  • MI, myocardial infarction
  • RITA, randomised intervention trial of unstable angina
  • TACTICS, treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy
  • TIMI, thrombolysis in myocardial infarction
  • unstable angina
  • myocardial infarction
  • randomised study
  • revascularisation
  • risk stratification
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Footnotes

  • Sources of support: The Pharmacia & Upjohn Company and the Swedish Heart-Lung Foundation.

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