Clinical risk stratification correlates with the angiographic extent of coronary artery disease in unstable angina

Objectives We sought to determine whether clinical risk stratification corr elates with the angiographic extent of coronary artery disease (CAD) in pat ient with unstable angina. Background The Agency for Health Care Policy and Research (AHCPR) guideline s stratify patients with unstable angina according to short term risk of my ocardial infarction or death. Whether these guidelines are useful in predic ting the extent of CAD is unknown. Methods All residents of Olmsted County, Minnesota, undergoing emergency de partment evaluation from January 1, 1985 through December 31, 1992 for unst able angina without a history of prior coronary artery bypass grafting, and who underwent early angiography (within seven days of presentation) were c lassified into low, intermediate and high risk subgroups based on AHCPR cri teria. Results Seven hundred ninety-five patients underwent early angiography: 159 high risk, 572 intermediate risk and 64 low risk patients. Logistic regres sion analysis demonstrated that low risk patients had a greater likelihood of normal or mild CAD relative to intermediate risk (odds ratio [OR], 4.67; 95% confidence interval [CI], 2.70-8.06; p < 0.001) and high risk (OR, 11. 1; 95% CI, 5.71-22.2; p < 0.001). Significant 1-, 2-,3-vessel coronary dise ase or left main coronary disease was more likely in high relative to low r isk (OR, 8.09; 95% CI, 4.22-15.5; p < 0.001), intermediate relative to low risk (OR, 4.11; 95% CI, 2.34-7.22; p < 0.001), and high relative to interme diate risk (OR, 1.97; 95% CI, 1.31-2.96; p = 0.0012). Conclusions Among patients with unstable angina undergoing early coronary a ngiography, risk stratification according to the AHCPR guidelines correlate s with the angiographic extent of CAD. (J Am Coll Cardiol 2001;37:2053-8) ( C) 2001 by the American College of Cardiology.