Clinical predictors of in-hospital prognosis in unstable angina: ECLA 3

Objectives Because of recent changes in the treatment of unstable angina, w e wonted to reassess the short-term prognostic value of clinical and echoca rdiographic variables. Methods This was an observational, prospective study thai included 1038 non selected consecutive patients admitted to coronary care units for unstable angina. Results Baseline characteristics were age 60.18 +/- 16 years, history of pr ior 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 con sisted 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 angiop lasty 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, th e independent predictors of myocardial infarction or death identified by mu ltivariate logistic regression analysis were ST-segment depression (odds ra tio [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 angin a 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 t han 65 years (OR 1.49, 95% CI 1.09 to 2.03, P = 0.03)was significantly rela ted to in-hospital death. The area under the receiver operating characteris tic curve for application of this model was 0.59. Sensitivity was 80% with a specificity of only 33%. Refractory angina after admission showed a stron g relation with an adverse short-term outcome. Conclusions With current therapy, clinical and electrocardiographic variabl es provide useful information about the short-term outcome of unstable angi na. However, this model has low specificity to identify high-risk patients. Future studies about the incremental value of the new serum markers such a s troponin T and C-reactive protein to assist in identification of high-ris k patients are necessary.