Long-term risk factors from non-invasive evaluation of patients with acute chest pain, but without myocardial infarction.
The aims were to identify long-term risk factors for cardiac events, i.e. cardiac death and non-fatal acute myocardial infarction (AMI), and for development of angina pectoris among patients admitted with acute chest pain, but without confirmed AMI (non-AMI). A total of 257 consecutive non-AMI patients without other severe disease and below 76 years of age were included. Medical history and variables from the ECG while exercising, thallium scintigrams, Holter-monitoring, echocardiography and chest X-ray were recorded. The patients were followed for 7 years regarding cardiac death, non-fatal AMI and development of angina pectoris. The variables recorded at admission were compared to follow-up results by means of Uni- and multivariate analyses. During follow-up, 69 cardiac events, 44 cardiac deaths and 25 non-fatal AMIs occurred. The following variables provided independent prognostic information (relative risk factors with 95% confidence limits in brackets): age (1.05, 1.01-1.09), abnormal ECG at rest (2.81, 1.33-5.90), low increase in rate pressure product (4.57, 2.21-9.44), multiform premature ventricular beats (VPB) (2.61, 1.34-5.09) and transient thallium defects (2.64, 1.33-5.24). Sub-analysis of patients with and without a history of coronary artery disease (CAD) prior to admission identified the following risk factors: (1) Patients with previous CAD: abnormal ECG on admission, low increase in rate pressure product, ST depression during exercise. (2) Patients without previous CAD: abnormal ECG at rest, multiform VPBs and low increase in rate pressure product. Development of angina pectoris during follow-up of patients without previous CAD could not be predicted by any of the variables.(ABSTRACT TRUNCATED AT 250 WORDS)
Launbjerg
J
J
Medical Department B, Frederiksborg County Central Hospital, Hillerød, Denmark.
Fruergaard
P
P
Jacobsen
H L
HL
Madsen
J K
JK
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors