title: Long-term prognosis of clinical variables, coronary reserve and extent of coronary disease in patients with a first episode of unstable angina.
abstract: Clinical and ECG prognostic markers, ischemic threshold (IT) and extent of coronary disease were analyzed in 383 patients with unstable angina (UA) and correlated with long-term events. Patients >74 years or those with severe heart failure or previous revascularization procedures were excluded. There were 369 events in 245 patients: 87 deaths, 96 myocardial infarction (MI), 111 coronary artery bypass grafting (CABG), and 75 angioplasty procedures (PTCA). Follow-up was obtained in 367 hospital survivors (99%, 114 (44) months) and ST depression on admission ECG, a modest enzyme rise, refractory angina (>2 episodes), two to three vessel coronary disease and a reduced IT (<==130 beats/min) were each associated with cardiac events. A multivariate analysis, however, showed refractory angina (p<0.001) and multivessel disease (p<0.001) as most significant predictors. After their exclusion, IT was most relevant predictor (p<0.001). However, the predictive value of these markers was essentially centered on first-year events (249, 67%). Moreover, refractory angina, minor enzyme rise and admission ST depression were each highly correlated with a reduced IT (p<0.006) and with multivessel disease (p<0.0001). Therefore, these findings underscore that the prognostic value of conventional clinical markers in patients with UA is limited to first-year events and that their remarkable correlation with extensive coronary disease and reduced coronary reserve reveal the anatomical substrate of this prognostic significance.
authors.affiliation: Unitat Coronària i Secció d' Hemodinàmica, Servei de Cardiologia, Hospital General Vall d'Hebron, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain. 5751jfb@comb.es
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.forename: Enric
authors.initials: E
authors.lastname: Domingo
authors.forename: Eduard
authors.initials: E
authors.lastname: Hermosilla
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012107:Research Design; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form