PREDICTIVE-VALIDITY OF THE BRAUNWALD CLASSIFICATION OF UNSTABLE ANGINA FOR ANGIOGRAPHIC FINDINGS, SHORT-TERM PROGNOSES, AND TREATMENT SELECTION

The authors tested the Braunwald classification for its predictive val idity for underlying coronary conditions, clinical courses, and respon ses to treatment. A reliable definition and classification of unstable angina is needed to help physicians make correct diagnoses of patient s' conditions and to appraise findings from clinical trials critically . Many clinical trials have been conducted, but it is difficult to com pare the results because of different entry criteria. Of 113 consecuti ve patients admitted with unstable angina, 89 who had primary angina w ere studied. Braunwald's classification was applied at admission: The outcomes of interest during hospitalization were coronary angiographic findings, shortterm prognoses, and the treatment selected. Multivaria te analysis showed that the severity class expressed significant posit ive predictivity for coronary thrombi (adjusted odds ratio [OR], 6.53; 95% confidence interval [CI], 2.82 to 15.1) and progress to impending infarction (OR, 10.43; CI, 3.35 to 32.49). The treatment (OR, 0.02; C I, 0.004 to 0.08) and electrocardiographic (OR, 0.22; CI 0.10 to 0.49) classes showed independent negative predictivity for coronary vasospa sm. The treatment (OR, 3.50; CI, 1.94 to 6.33) and electrocardiographi c (odds ratio, 3.27; CI, 1.87 to 5.71) classes showed positive predict ivity for the necessity for recanalization treatment with coronary ang ioplasty or bypass grafting. The Braunwald classification used at admi ssion is highly predictive of underlying coronary conditions, progress ion to impending infarction, and the final selection of treatment. Thi s classification should be considered in determining patient eligibili ty in clinical trials and studies.