Predictors of long term outcome in medically treated patients with unstable angina
Drozdz, J.; Krzeminzska-Pakula, M.; Chrzanowski, L.; Plewka, M.; Ciesielczyk, M.; Kasprzak, J.D.
Canadian Journal of Cardiology 19(2): 135-139
2003
ISSN/ISBN: 0828-282X PMID: 12601437 Document Number: 554859
BACKGROUND: The choice of invasive or noninvasive strategy for low risk patients with unstable angina is a challenge. OBJECTIVES: To investigate the impact of clinical factors on adverse outcomes in patients receiving successful medical treatment and referred from the hospital without invasive procedures. METHODS: The study group consisted of 166 patients (54% men, age 63+-11 years) who were discharged symptom free after pharmacological treatment of unstable angina. The authors analyzed demographic, clinical, electrocardiographic, echocardiographic and laboratory parameters. RESULTS: During two years of follow-up, the mortality rate was 4.2%. A composite end point (coronary disease hospitalization, recurrent unstable angina, necessity for revascularization or death) occurred in 99 patients (60%). In multivariate logistic regression, the Canadian Cardiovascular Society (CCS) class (P=0.015) and the left ventricular ejection fraction (P=0.01) were independently predictive for the adverse events. A scoring system was proposed for simple risk stratification, with one point assigned to the patient for CCS class III or IV and left ventricular ejection fraction below 40%, thus yielding a score in the range of 0 to 2. The adverse event rates for total scores of 0, 1 and 2 were 37%, 64% and 86%, respectively. CONCLUSIONS: Uncomplicated follow-up in medically treated patients with unstable angina is rare. Patients with CCS class III and IV or left ventricular ejection fraction below 40% have particularly high rates of recurrent ischemia.