Predictors of multivessel disease in cases of acute chest pain

Patients with unstable angina not showing ischemia at the exercise treadmill test after medical stabilization usually have a low-risk coronary anatomy. However, some of them have multivessel disease, and it is not known what characteristics are associated with the extension of the coronary artery disease in this subset of patients.

To determine clinical and exertional characteristics associated with multivessel disease in patients with unstable angina and a negative exercise test.

312 hospitalised patients with unstable angina and a negative exercise test who had undergone cardiac catheterization were reviewed. The relationship between coronariographic findings (presence of multivessel disease) and clinical characteristics, exercise parameters and left ventricular function was studied.

Multivessel disease was present in 97 patients (31%). The following variables were associated with the presence of multivessel disease: age more than 65 years old, previous myocardial infarction, previous admissions because of unstable angina, peripheral artery disease, presence of more than two coronary risk factors, left ventricular dysfunction, functional capacity less than 6 METS, duration of exercise less than 8 min and less than 85% of the maximum heart rate. Multivariate analysis showed, as independent predictors of multivessel disease: previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease.

In patients with medically stabilized unstable angina and a negative exercise test, previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease, but not exercise parameters, are independent predictors of multivessel disease.