CORRELATION OF CLINICAL AND ELECTROCARDIOGRAPHIC VARIABLES WITH CORONARY LESIONS IN UNSTABLE ANGINA-PECTORIS

The relation of clinical and electrocardiographic variables to the sev erity of coronary lesions in unstable angina was studied in 84 men and 8 women, aged thirty-nine to seventy-five, who were subjected to coro nary arteriography within two weeks. Eighty-seven patients (94.6%) had significant stenosis (50% of the diameter) of at least one vessel, wh ereas 5 (5.4%) had normal coronary arteries. Eleven (12%) had one-vess el disease, 13 (14%) had two-vessel, and 63 (68.5%) had three-vessel d isease. Twelve (13%) had also significant left main stem stenosis. Exc ept for 1 patient with artificial pacemaker, three-vessel and/or left main stem disease was present in 20 (100%) patients with ST segment de viation greater than or equal to 0.2mV as compared with 20 of 36 patie nts (55.5%) with ST segment deviation of 0.1-0.19 mV and 24 of the 35 (68.6%) with no additional ECG changes or with T wave inversion only ( P < 0.005). The direction of ST segment deviation (elevation or depres sion) made no difference. Preexisting angina or infarction was associa ted with three-vessel disease and/or left main stem disease in 74.1% a nd 81.4%, respectively, as compared with 45.5% (P=0.05) of the patient s with angina of recent onset. Pain at rest persisting for more than f orty-eight hours was associated with three-vessel and/or main stem dis ease in 93.1% of the patients as compared with 60.3% of patients in wh om rest angina subsided within forty-eight hours (P < 0.01). In the mu ltivariable analysis the duration of unstable angina (P=0.010), the de gree of the ST segment deviation (P=0.006), age (P=0.011), and possibl y preexisting myocardial infarction (P=0.076) were associated with the number of the diseased vessels. In contrast, sex (P=0.370), blood pre ssure 2 160/90 mmHg (P=0.619), smoking (P=0.249), diabetes mellitus (P =0.797), and preexisting ischemic heart disease (P=0.509) were not sig nificant factors in the extent of the coronary lesions.