Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation XXXX .

@entity1 @entity1187 @entity8 @entity712 @entity583 @entity3657 @entity303 @entity177 @entity453
OBJECTIVE: To investigate comorbid conditions with prognostic influence in non-ST-segment elevation @entity1187 (NSTEACS). @entity1 AND METHODS: The study group consisted of a derivation cohort of 1017 @entity1 (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 @entity1 (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and @entity453 -specific index, were recorded. The main outcome was one-year mortality. RESULTS: During follow-up, 103 @entity1 died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild @entity177 (hazard ratio [HR], 2.9 and HR, 1.6, respectively), @entity303 (HR, 3.1), @entity3657 (HR, 2.0), previous @entity712 (HR, 2.6), and previous @entity583 (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P = .0001). Adding the SCI, Charlson comorbidity index, or @entity453 -specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P = .001), without significant differences among the 3 indices. In @entity1 with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P = .001). CONCLUSION: @entity8 , @entity303 , @entity3657 , previous @entity712 , and previous @entity583 are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of @entity1 with comorbid conditions merits further investigation.
