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Fibrinogen, ejection fraction and Killip classification as mortality prediction factors in acute coronary syndrome


In patients with acute coronary syndrome, there is a relation between the patient's outcome and multivariate group of coronary risk factors. The aim of this investigation is to develop a predictive equation of mortality in patients with acute coronary disease, taking those factors with mortality risk significantly higher to predict acute coronary disease's outcomes.



Between April to September 2001, were followed 53 patients with acute coronary disease (18 unstable anginas and 35 acute myocardial infarcts). Ninety-two variables between clinical, laboratory and echocardiography were analyzed.

Statistical analysis

Database was analyzed using SPSS 9.0 for Windows. Forward stepwise logistic regression model was used to analyze the joint association of multiple covariates with overall mortality. No missing covariate data was found. The result constant and B coefficients was include in the equation (Z function) to predict the patient's outcome. Values of P < 0.05 were considered statistically significant.


Mortality risk

Logistic regression analysis was used to examine the effects of multiple covariates (92) on the overall mortality risk and we found this major cardiovascular mortality risk factors: age, heart rate, pain duration, blood nitrogen ureic, fibrinogen, Killip and ejection fraction. A new logistic regression analysis was applied to these covariates (8) with the objective to obtain those with prediction power higher to explain the patient's outcome. In this step were included: blood fibrinogen, Killip classification and ejection fraction.

During follow-up, eight of 53 patients died of cardiac causes (15%). The mortality rates of death increased with a fibrinogen ≥ 333 mg/dl (Fig. 1; P = 0.001, with a mean valor of 405 mg/dl). Likewise the mortality rates increased with Killip classification increases (Fig. 2) and with ejection fraction ≤ 48% (Fig. 3; P = 0.001, with a mean valor of 40.1%).

Figure 1
figure 1

Fibrinogen seric concentration in patients with non-fatal acute coronary disease (ACD) and cardiovascular (CV) death.

Figure 2
figure 2

Mortality rates by Killip classification.

Figure 3
figure 3

Ejection fraction in patients with non-fatal acute coronary disease (ACD) or cardiovascular (CV) death.

With these predictors was developed a mortality predictive equation (Z function) using a constant (K = -11.4997) and the B coefficients of each covariate (fibrinogen: 0.0268, Killip: 1.947 and ejection fraction: -0.0974). The equation obtained was: death probability (P)= (-11.49) + (0.268 × fibrinogen) + (1.971 × Killip) + (-0.974 × FE%).

The death probability increases when P value increases from 0.5 to 1. The prognostic of patient's outcome was tested and compared with the real patient's outcome. It shows a sensibility 71% and specificity 97%.


Blood fibrinogen, ejection fraction and Killip classification were major independent covariates that predict patient's outcome in acute coronary disease.

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Del Cid, W., Lopez, M. & Segura, V. Fibrinogen, ejection fraction and Killip classification as mortality prediction factors in acute coronary syndrome. Crit Care 6 (Suppl 1), P154 (2002).

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