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[Immediate and late prognosis in patients with unstable angina under medical treatment]
Insights
This study tracked 221 unstable angina (UA) patients, finding significant long-term risks. Key factors like ST depression and hypertension predict poor outcomes, emphasizing the need for early intervention in coronary heart disease management.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Unstable angina (UA) is a critical manifestation of coronary heart disease (CHD).
- Predicting adverse outcomes in UA patients is essential for timely intervention and improved prognosis.
- Long-term follow-up is crucial for understanding the full impact of UA.
Purpose of the Study:
- To assess the long-term outcomes of unstable angina (UA).
- To identify significant predictors of myocardial infarction and sudden coronary death in UA patients.
- To evaluate the mortality rates associated with UA over a 5-year period.
Main Methods:
- Prospective study of 221 patients with unstable angina (UA).
- Inclusion of acute phase assessment and repeated follow-up for an average of 5.3 years.
- Utilized Cox's proportional hazards model to identify risk factors for adverse events.
Main Results:
- Hospital mortality was 5.8%, with 15% developing myocardial infarction during hospitalization.
- Late-period myocardial infarction occurred in 31 of 175 discharged patients.
- Five-year mortality reached 28.2%, with significant predictors including ST segment depression, duration of CHD, and history of hypertension.
Conclusions:
- Unstable angina (UA) carries a substantial risk of myocardial infarction and mortality, even years after the acute phase.
- Several clinical and historical factors, including ECG changes and patient history, are significant predictors of poor outcomes.
- Risk stratification using identified factors is vital for managing patients with unstable angina and coronary heart disease.
Abstract:
The study was undertaken to examine 221 patients with unstable angina (UA) in the acute period and repeatedly on average of 5.3 years later. Myocardial infarction and sudden coronary death were regarded as unfavorable outcomes of UA. Out of all the patients included into the study, 33 (15%) developed myocardial infarction on days 2-28 of hospital stay, which resulted in death in 7 patients; 6 more patients died suddenly. The hospital mortality rate was 5.8%. Of 175 patients discharged from the unit, 31 developed myocardial infarction in the late period, 1 case ended with a fatal outcome, sudden coronary death was observed in 32 cases. The mortality rates by years were the following: 10.2% within the first year, 17.4% for 3 years, and 28.2% for 5 years. The choice of a complex of initial signs mostly significant for defining the risk for complications with the use of Cox's model of proportional risks indicated that the outcome of UA was affected by the following significant factors: 1) ST segment depression in the leads V4-V6; 2) duration of aggravated condition; 3) duration of coronary heart disease; 4) the number of resting anginal episodes; 5) a patient's fitness on his admission to hospital; 6) a history of arterial hypertension; 7) negative T waves in the leads V4-V5.