Document Detail


Clinical predictors of in-hospital prognosis in unstable angina: ECLA 3. The ECLA Collaborative Group.
MedLine Citation:
PMID:  9924167     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Because of recent changes in the treatment of unstable angina, we wanted to reassess the short-term prognostic value of clinical and echocardiographic variables. METHODS: This was an observational, prospective study that included 1038 nonselected consecutive patients admitted to coronary care units for unstable angina. RESULTS: Baseline characteristics were age 60.18 +/- 16 years, history of prior myocardial infarction in 336 patients (32%), and a history of previous angina in 817 patients (78.7%). Angina during the 48 hours before admission was observed in 1004 patients (96.7%) and ST-segment changes on admission electrocardiogram occurred in 385 patients (37%). In-hospital treatment consisted of nitrates in 81.4% of patients, aspirin in 88.6%, beta-blockers in 71%, intravenous heparin in 34.5%, subcutaneous heparin in 23%, and angioplasty or coronary artery bypass grafting in 25.1%. After admission, angina occurred in 443 patients (40.8%), refractory angina in 223 patients (21.5%), and death or myocardial infarction in 84 patients (8.1%). At admission, the independent predictors of myocardial infarction or death identified by multivariate logistic regression analysis were ST-segment depression (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.23 to 3.68, P =.006), prior angina (OR 2.23, 95% CI 0.98 to 5.05, P =.05), number of episodes of angina within the previous 48 hours (OR 1.63, 95% CI 0.98 to 2.70, P =.05), and history of smoking (OR 0.69, 95% CI 0.56 to 0.85, P =.004). Age greater than 65 years (OR 1.49, 95% CI1.09 to 2.03, P = 0.03) was significantly related to in-hospital death. The area under the receiver operating characteristic curve for application of this model was 0.59. Sensitivity was 80% with a specificity of only 33%. Refractory angina after admission showed a strong relation with an adverse short-term outcome. CONCLUSIONS: With current therapy, clinical and electrocardiographic variables provide useful information about the short-term outcome of unstable angina. However, this model has low specificity to identify high-risk patients. Future studies about the incremental value of the new serum markers such as troponin T and C-reactive protein to assist in identification of high-risk patients are necessary.
Authors:
O Bazzino; R Díaz; C Tajer; C Paviotti; E Mele; M Trivi; A Piombo; A H Prado; E Paolasso
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  American heart journal     Volume:  137     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-02-25     Completed Date:  1999-02-25     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  322-31     Citation Subset:  AIM; IM    
Affiliation:
Servicio de Cardiología, Hospital Italiano, Buenos Aires, Argentina.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Unstable / epidemiology*,  mortality,  therapy
Electrocardiography
Female
Hospital Mortality
Hospitalization
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / epidemiology
Prognosis
Prospective Studies
ROC Curve
Recurrence
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Time Factors
Comments/Corrections
Comment In:
Am Heart J. 1999 Dec;138(6 Pt 1):1197-8   [PMID:  10577456 ]
Am Heart J. 1999 Feb;137(2):199-202   [PMID:  9924149 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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