MANAGEMENT OF PATIENTS WITH UNSTABLE ANGINA IN A GENERAL CARDIOLOGY UNIT

Aims. To review the clinical management of patients with unstable angi na and to relate prospectively initial risk stratification, according to the Braunwald criteria, to subsequent cardiovascular events. Method s. From February to April 1996 we performed a three month prospective review of all patients with a diagnosis of unstable angina admitted to the coronary care unit at Auckland Hospital. Results. One hundred and four patients (61% male), with a mean age of 64 years, were classifie d as high (58%), intermediate (41%) or low risk (1%) for an adverse ca rdiac event. Twelve (12%) patients had a documented myocardial infarct ion, of whom 11 were in the high-risk group (p=0.038). During hospital isation there was one death. Twelve (12%) patients underwent inpatient exercise testing, five of whom proceeded to a coronary angiogram prio r to hospital discharge. Twenty-two (21%) unstable patients underwent inpatient angiography without prior exercise testing. Twenty-one (20%) patients required revascularisation on the same admission: percutaneo us coronary angioplasty (n=14) or coronary artery bypass grafting (n=7 ). Twelve of these 21 patients mere in the high-risk group (p=0.999, N S). Conclusion. Patients admitted with unstable angina had low inpatie nt mortality but a 12% rate of subsequent myocardial infarction. Braun wald low-risk unstable angina patients were not admitted to the corona ry care unit. Braunwald high-risk patients were more likely to develop a subsequent myocardial infarction. Stratification of patients into i ntermediate or high-risk groups did not relate to initial medical mana gement or subsequent revascularisation. Thus, while this method of ris k stratification may predict cardiovascular events, it may be of limit ed clinical use in the New Zealand environment.