Risk stratification and prognosis of patients with recent onset angina

We prospectively assessed coronary artery disease and natural history in a series of 104 patients (99 males, mean age 52±8 years) admitted with recent onset angina (defined as a history of angina of < 1 month duration). Coronary angiography showed one-vessel disease in 31, two-vessel disease in 22 and three-vessel disease in 14; 37 patients had normal coronary arteries. After a mean follow-up of 36 (range 1 to 52) months, one patient died, 13 sustained a myocardial infarction and 21 underwent surgery. The univariate analysis showed four of 12 clinical features derived from clinical history and data from CCU (exertional angina (P<0.001), repeated episodes of chest pain before admission (P<0.001), an abnormal baseline electrocardiogram (P<0.001), and recurrence of angina (P<0.05)) to be associated with the presence of coronary artery disease. These clinical features were termed clinical risk characteristics. Three-year probability of medical events (death or acute myocardial infarction) for patients with 0.1 clinical risk characteristics was 0 and that of combined events (need for revascularization with or without a preceding medical event) 0.11, whereas patients with 2 or more risk characteristics had probabilities of 0.27 and 0.49, respectively. Multivariate analysis identified the number of clinical risk characteristics as the only independent predictor of medical events (P<0.002) and a positive thallium stress test (P<0.0001), the number of clinical risk characteristics (P<0.002) and the number of involved arteries (P<0.002), as independent predictors of combined events. With the identification of a high-risk group of patients with recent onset angina it appears that a more cost effective and rational medical approach can now be achieved in the management of this condition.