title: Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease.
abstract: OBJECTIVE
  In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.
  
  
  RESULTS
  The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 microgram.l-1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P < 0.05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P < 0.05) and for patients with and without creatinine kinase-MB > or = 6 microgram.l-1 the event rate was 23% and 8% respectively (P < 0.01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental.
  
  
  CONCLUSIONS
  Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.
authors.affiliation: Department of Medicine, Ostra University Hospital, Göteborg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Andersen
authors.forename: P
authors.initials: P
authors.lastname: Eriksson
authors.forename: M
authors.initials: M
authors.lastname: Dellborg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D003402:Creatine Kinase / Q000097:blood*; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012306:Risk; D012815:Signal Processing, Computer-Assisted; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014672:Vectorcardiography / Q000706:statistics & numerical data*
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase