Predictors of long term outcome in medically treated patients with unstable angina.

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.