[Correlation of coronary angiographic morphology with clinical presentation in unstable angina].

OBJECTIVE

To seek the relation between clinical presentation (Braunwald classification) or electrocardiogram(ECG) and angiographic morphology in patients with unstable angina (UA) and to determine which clinical markers could reliably predict unstable lesions and in-hospital cardiac events.

METHODS

120 hospitalized patients with a clinical diagnosis of UA and an abnormal angiograms(>or=50% diameter stenosis) were selected. Patients were classified according to Braunwald criteria before cardiac catheterization was performed. Coronary arteriograms were reviewed. The lesion morphology (including simple lesion, complex lesion and intracoronary thrombus [ICT]) and in-hospital events (including acute myocardial infarction,cardiac death and prompt revascularization) were observed. Logistic regression was used to evaluate the ability of clinical markers (Braunwald classification or an abnormal ST segment of ECG) to predict unstable lesions and cardiac events.

RESULTS

There were more complex lesions in class III group(61%, or 20 of 33) than in class I group(30%, or 13 of 43, P < 0.05) and more ICT in class III group(18%, or 6 of 33) than in class II group (2%, or 1 of 44, P < 0.05). The rate of cardiac events was higher in class III patients (58%, or 19 of 33) than in class I patients (19%, or 8 of 43, P = 0.01 ) or class II patients (25%, or 11 of 44, P < 0.01). Logistic regression analysis demonstrated that an abnormal ST segment of ECG or Braunwald class III were highly predictive of the presence of complex lesion morphology (P < 0.01, OR 4.9; P < 0.01, OR 3.3, respectively). An abnormal ECG was the single predictive clinical indicator of triple vessel disease (P < 0.01, OR 3.9) and cardiac events (P < 0.001, OR 4.8).

CONCLUSION

Complex lesion can be best identified by the clinical feature of recent onset refractory angina at rest and abnormal ST segment of ECG in UA patients. Patients with abnormal ST segment represents a high risk of triple vessel disease and cardiac events.