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Unstable angina: relationship of clinical presentation, coronary artery pathology, and clinical outcome
B D Bertolet1, J Dinerman, R Hartke
1Department of Medicine, University of Florida College of Medicine, Gainesville, Florida.
Insights
Classifying unstable angina patients by clinical history did not predict myocardial infarction or recurrent angina. However, unstable angina postinfarction showed higher mortality than preinfarction, indicating a poorer prognosis.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Unstable angina (UA) patients exhibit diverse presentations and outcomes.
- Clinical subclassification of UA has been proposed for risk stratification.
Purpose of the Study:
- To evaluate the predictive value of clinical subclassification of UA for cardiac events.
- To assess the utility of UA subclassification in identifying patients at increased cardiac risk.
Main Methods:
- 129 acute myocardial ischemia patients were classified into recent onset UA preinfarction, crescendo UA preinfarction, and UA postinfarction groups.
- Patients were subclassified based on angina patterns (effort, rest, or both).
- Cardiac events (recurrent angina, myocardial infarction, death) were assessed at 12 months post-discharge.
Main Results:
- Mortality was significantly higher in the UA postinfarction group (7.7%) compared to the UA preinfarction group (1.1%).
- Coronary artery thrombus was more frequent in crescendo rest angina preinfarction and frequent rest angina postinfarction.
- No significant differences in myocardial infarction or recurrent angina requiring revascularization were observed between subgroups.
Conclusions:
- Clinical subclassification of UA is not a reliable predictor of subsequent myocardial infarction or recurrent angina.
- The UA postinfarction classification indicates a significantly higher mortality risk.
- Further research may be needed to refine risk stratification strategies for unstable angina.
Abstract:
Patients with unstable angina are heterogeneous with respect to presentation, coronary artery morphology, and clinical outcome. Subclassification of these patients based on clinical history has been proposed as a means of identifying individuals at increased cardiac risk. We applied such a classification system to 129 patients discharged from a coronary care unit with a diagnosis of acute myocardial ischemia. Patients were then assessed for cardiac events (recurrent angina requiring revascularization, myocardial infarction, death) 12 months following hospital discharge. Patients were classified as recent onset unstable angina preinfarction (n = 42), crescendo unstable angina preinfarction (n = 48), and unstable angina postinfarction (n = 39). Within each of these groups, the patients were further subclassified based on the occurrence of angina on effort, at rest, or both. No attempt was made to subset patients taking anti-ischemic drugs at the time of clinical presentation to the physician. Coronary angiographic pathology (morphology and number of vessels involved) was similar in the subgroups, but coronary artery thrombus was statistically more likely to be found in patients with crescendo rest angina preinfarction or with frequent anginal episodes at rest postinfarction. Mortality was significantly higher for patients with unstable angina postinfarction (7.7%) than preinfarction (1.1%). No statistical differences were noted between the subgroups with respect to the occurrence of myocardial infarction or recurrent unstable angina requiring revascularization. These data suggest that subclassification of unstable angina patients based on clinical characteristics at presentation is not useful to predict subsequent myocardial infarction or recurrent angina requiring revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)