CLINICAL PREDICTORS OF UNSTABLE CORONARY LESION MORPHOLOGY

We evaluated prospectively clinical and angiographic data in 400 patie nts, 200 with unstable and 200 with stable angina in order to determin e which clinical markers could reliably predict unstable coronary arte ry lesions. Comparison of the angiogram of 200 patients with unstable and 200 with stable angina revealed a high-grade lesion (42% vs 23%, P <0.0001), complex lesion morphology (49% vs 20%, P<0.0001) and thrombu s-containing lesions (7% vs 1%, P=0.006) as typical findings in patien ts,vith unstable angina. A high-grade lesion and/or complex lesion (in cluding thrombotic lesions but excluding total occlusion) was found in 61% of unstable and 34% of stable patients (P<0.0001). Clinical featu res including the Braunwald classification of unstable angina were the n evaluated by means of a multivariate approach with regard to their a bility to predict the presence of unstable coronary artery lesions. Mu ltivariate analysis revealed an abnormal ECG as the single most predic tive clinical indicator of complex lesion morphology (P<0.0001, odds r atio 4,2). The clinical presentation of recent onset of angina was hig hly predictive of a high grade lesion (P=0.0003, odds ratio 3,2). The endpoint of a high-grade and/or a complex lesion was identified by an abnormal ECG (P=0.0015, odds ratio 3,0) and recent onset angina (P=0.0 119, odds ratio 2,5). Thus, a high grade and/or complex lesion, typica l of patients with unstable angina,was best identified by the clinical feature of recent onset angina and/or abnormal ECG changes.