K. Andersen et al., NONINVASIVE RISK STRATIFICATION WITHIN 48 H OF HOSPITAL ADMISSION IN PATIENTS WITH UNSTABLE CORONARY-DISEASE, European heart journal, 18(5), 1997, pp. 780-788
Aims In this study we evaluated the prognostic value of three methods
of early risk estimation in patients with unstable coronary disease. M
ethods and results The methods evaluated were: clinical risk estimatio
n at hospital admission, continuous ST analysis with computerized vect
orcardiography for 24 h and serial measurements of creatinine kinase-M
B for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-f
atal infarction within one year. Clinical risk evaluation correctly id
entified a subgroup of patients with low risk but did not otherwise pr
edict outcome. Fifty-six (29%) patients had ST vector magnitude episod
es on vectorcardiography, 70 (38%) had three or more episodes of ST ch
ange vector magnitude and 74 (38%) had a peak creatinine kinase-MB val
ue of 6 mu g.l(-1) or more. The even rate for patients with ST vector
magnitude episodes (23%) was significantly higher than for those witho
ut (10%; P<0.05). For patients with and without three or mon episodes
of ST change vector magnitude the event rate was 23% and 9% respective
ly (P<0.05) and for patients with and without creatinine kinase-MB gre
ater than or equal to 6 mu g.l(-1) the event rate was 23% and 8% respe
ctively (P<0.01). The positive predictive value of having none, either
one or both of the ST or creatinine kinase-MB markers positive was in
cremental. Conclusion Continuous vectorcardiographic monitoring of isc
haemia in combination with serial creatinine kinase-MB measurement con
siderably improves risk stratification in unstable coronary disease.