The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.
We evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +/- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p less than 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p less than 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients.
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D006332:Cardiomegaly / Q000000981:diagnostic imaging; D003327:Coronary Disease / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D011122:Polyphosphates; D011859:Radiography; D011877:Radionuclide Imaging; D012044:Regression Analysis; D012306:Risk; D013667:Technetium; D016698:Technetium Tc 99m Pyrophosphate; D014003:Tin Polyphosphates
D011122:Polyphosphates; D014003:Tin Polyphosphates; C017742:technetium Tc 99m stannous pyrophosphate; D016698:Technetium Tc 99m Pyrophosphate; D013667:Technetium