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Predictors of long term outcome in medically treated patients with unstable angina
Jaroslaw Drozdz1, Maria Krzeminzska-Pakula, Lukasz Chrzanowski
1Department of Cardiology, Medical University of Lódz, Lódz, Poland. drozdz@ptkardio.pl
Insights
Uncomplicated follow-up is rare for patients with unstable angina treated medically. High-risk factors like Canadian Cardiovascular Society class III/IV or low ejection fraction predict adverse events.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Managing unstable angina involves choosing between invasive and noninvasive strategies, particularly for low-risk patients.
- Determining the optimal approach for these patients presents a clinical challenge.
Purpose of the Study:
- To assess the impact of clinical factors on adverse outcomes in patients with unstable angina.
- Focus on patients who received successful medical treatment and were discharged without invasive procedures.
Main Methods:
- A cohort of 166 patients (54% male, mean age 63 years) discharged symptom-free after pharmacological treatment for unstable angina was studied.
- Analysis included demographic, clinical, electrocardiographic, echocardiographic, and laboratory parameters over a two-year follow-up period.
Main Results:
- The two-year mortality rate was 4.2%, with a composite endpoint (hospitalization, recurrent angina, revascularization, or death) occurring in 60% of patients.
- Multivariate analysis identified Canadian Cardiovascular Society (CCS) class and left ventricular ejection fraction (LVEF) as independent predictors of adverse events.
- A risk score based on CCS class III/IV and LVEF <40% showed increasing adverse event rates (37%, 64%, 86%) for scores of 0, 1, and 2, respectively.
Conclusions:
- Medically treated unstable angina patients rarely experience uncomplicated follow-up.
- Patients with CCS class III/IV or LVEF <40% face a significantly higher risk of recurrent ischemia and adverse outcomes.
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.