NONINVASIVE RISK STRATIFICATION WITHIN 48 H OF HOSPITAL ADMISSION IN PATIENTS WITH UNSTABLE CORONARY-DISEASE

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.