Long-term survival and risk stratification in patients with angina at rest undergoing medical treatment.
In order to determine those factors which influence long-term prognosis in patients with angina at rest associated with transient ST-segment changes, 217 patients undergoing medical treatment were followed for a mean of 39 months. All patients underwent coronary arteriography. Univariate analysis identified 12 variables significantly related to prognosis. These were disease of the left main coronary artery; the number of diseased vessels; left ventricular end-diastolic pressure; ejection fraction; baseline electrocardiogram; presence of prior myocardial infarction; ST-segment depression and ventricular arrhythmias during pain; disease of the proximal anterior descending coronary artery; crescendo angina; hypertension; and age. Use of the Cox regression model for survival analysis revealed only 3 variables which were independent predictors of prognosis. They were disease of the left main coronary artery; the number of diseased vessels and left ventricular end-diastolic pressure. The model allowed stratification of patients into 3 groups. Survival at 3 years was 98% in the low risk group; 82% in the intermediate risk group; and 58% in the high risk group. These data indicate that disease of the left main coronary artery, the number of diseased vessels and left ventricular end-diastolic pressure are the independent predictors of prognosis in angina at rest. These variables may allow stratification of patients into groups having different long-term survivals.
De Servi
S
S
Divisione di Cardiologia, Policlinico San Matteo, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy.
Berzuini
C
C
Poma
E
E
Ferrario
M
M
Ghio
S
S
Sciré
A
A
Cioffi
P
P
Ardissino
D
D
Montemartini
C
C
Specchia
G
G
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage*; D005996:Nitroglycerin / Q000008:administration & dosage*; D011379:Prognosis; D011433:Propranolol / Q000008:administration & dosage*
D011433:Propranolol; D005996:Nitroglycerin; D009543:Nifedipine