Drozdz Jaroslaw, Krzeminzska-Pakula Maria, Chrzanowski Lukasz, Plewka Michal, Ciesielczyk Michal, Kasprzak Jaroslaw D
Department of Cardiology, Medical University of Lódz, Lódz, Poland.
Can J Cardiol. 2003 Feb;19(2):135-9.
The choice of invasive or noninvasive strategy for low risk patients with unstable angina is a challenge.
To investigate the impact of clinical factors on adverse outcomes in patients receiving successful medical treatment and referred from the hospital without invasive procedures.
The study group consisted of 166 patients (54% men, age 63+/-11 years) who were discharged symptom free after pharmacological treatment of unstable angina. The authors analyzed demographic, clinical, electrocardiographic, echocardiographic and laboratory parameters.
During two years of follow-up, the mortality rate was 4.2%. A composite end point (coronary disease hospitalization, recurrent unstable angina, necessity for revascularization or death) occurred in 99 patients (60%). In multivariate logistic regression, the Canadian Cardiovascular Society (CCS) class (P=0.015) and the left ventricular ejection fraction (P=0.01) were independently predictive for the adverse events. A scoring system was proposed for simple risk stratification, with one point assigned to the patient for CCS class III or IV and left ventricular ejection fraction below 40%, thus yielding a score in the range of 0 to 2. The adverse event rates for total scores of 0, 1 and 2 were 37%, 64% and 86%, respectively.
Uncomplicated follow-up in medically treated patients with unstable angina is rare. Patients with CCS class III and IV or left ventricular ejection fraction below 40% have particularly high rates of recurrent ischemia.
对于低风险不稳定型心绞痛患者，选择侵入性或非侵入性治疗策略是一项挑战。
探讨临床因素对接受成功药物治疗且未接受侵入性操作而从医院转诊的患者不良结局的影响。
研究组由166例患者（男性占54%，年龄63±11岁）组成，这些患者在接受不稳定型心绞痛药物治疗后无症状出院。作者分析了人口统计学、临床、心电图、超声心动图和实验室参数。
在两年的随访期间，死亡率为4.2%。99例患者（60%）出现了复合终点事件（冠心病住院、复发性不稳定型心绞痛、血管重建必要性或死亡）。在多因素逻辑回归分析中，加拿大心血管学会（CCS）分级（P=0.015）和左心室射血分数（P=0.01）是不良事件的独立预测因素。提出了一种简单的风险分层评分系统，CCS分级为III或IV级且左心室射血分数低于40%的患者得1分，因此得分范围为0至2分。总得分0、1和2的不良事件发生率分别为37%、64%和86%。
接受药物治疗的不稳定型心绞痛患者进行无并发症的随访情况很少见。CCS分级为III和IV级或左心室射血分数低于40%的患者复发性缺血发生率特别高。
