Bazzino O, Díaz R, Tajer C, Paviotti C, Mele E, Trivi M, Piombo A, Prado A H, Paolasso E
Servicio de Cardiología, Hospital Italiano, Buenos Aires, Argentina.
Am Heart J. 1999 Feb;137(2):322-31. doi: 10.1053/hj.1999.v137.93029.
Because of recent changes in the treatment of unstable angina, we wanted to reassess the short-term prognostic value of clinical and echocardiographic variables.
This was an observational, prospective study that included 1038 nonselected consecutive patients admitted to coronary care units for unstable angina.
Baseline characteristics were age 60.18 +/- 16 years, history of prior myocardial infarction in 336 patients (32%), and a history of previous angina in 817 patients (78.7%). Angina during the 48 hours before admission was observed in 1004 patients (96.7%) and ST-segment changes on admission electrocardiogram occurred in 385 patients (37%). In-hospital treatment consisted of nitrates in 81.4% of patients, aspirin in 88.6%, beta-blockers in 71%, intravenous heparin in 34.5%, subcutaneous heparin in 23%, and angioplasty or coronary artery bypass grafting in 25.1%. After admission, angina occurred in 443 patients (40.8%), refractory angina in 223 patients (21.5%), and death or myocardial infarction in 84 patients (8.1%). At admission, the independent predictors of myocardial infarction or death identified by multivariate logistic regression analysis were ST-segment depression (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.23 to 3.68, P =.006), prior angina (OR 2.23, 95% CI 0.98 to 5.05, P =.05), number of episodes of angina within the previous 48 hours (OR 1.63, 95% CI 0.98 to 2.70, P =.05), and history of smoking (OR 0.69, 95% CI 0.56 to 0.85, P =.004). Age greater than 65 years (OR 1.49, 95% CI1.09 to 2.03, P = 0.03) was significantly related to in-hospital death. The area under the receiver operating characteristic curve for application of this model was 0.59. Sensitivity was 80% with a specificity of only 33%. Refractory angina after admission showed a strong relation with an adverse short-term outcome.
With current therapy, clinical and electrocardiographic variables provide useful information about the short-term outcome of unstable angina. However, this model has low specificity to identify high-risk patients. Future studies about the incremental value of the new serum markers such as troponin T and C-reactive protein to assist in identification of high-risk patients are necessary.
由于近期不稳定型心绞痛治疗方法的改变，我们想要重新评估临床和超声心动图变量的短期预后价值。
这是一项观察性前瞻性研究，纳入了1038例因不稳定型心绞痛入住冠心病监护病房的未经挑选的连续患者。
基线特征为年龄60.18±16岁，336例患者（32%）有既往心肌梗死病史，817例患者（78.7%）有既往心绞痛病史。1004例患者（96.7%）在入院前48小时内出现心绞痛，385例患者（37%）入院心电图有ST段改变。住院治疗包括81.4%的患者使用硝酸盐类药物，88.6%的患者使用阿司匹林，71%的患者使用β受体阻滞剂，34.5%的患者使用静脉肝素，23%的患者使用皮下肝素，25.1%的患者进行血管成形术或冠状动脉旁路移植术。入院后，443例患者（40.8%）出现心绞痛，223例患者（21.5%）出现难治性心绞痛，84例患者（8.1%）死亡或发生心肌梗死。入院时，多因素逻辑回归分析确定的心肌梗死或死亡的独立预测因素为ST段压低（比值比[OR]2.13，95%置信区间[CI]1.23至3.68，P = 0.006）、既往心绞痛（OR 2.23，95%CI 0.98至5.05，P = 0.05）、前48小时内心绞痛发作次数（OR 1.63，95%CI 0.98至2.70，P = 0.05）和吸烟史（OR 0.69，95%CI 0.56至0.85，P = 0.004）。年龄大于65岁（OR 1.49，95%CI1.09至2.03，P = 0.03）与住院死亡显著相关。该模型应用的受试者工作特征曲线下面积为0.59。敏感性为80%，特异性仅为33%。入院后难治性心绞痛与不良短期结局密切相关。
采用当前治疗方法时，临床和心电图变量可提供有关不稳定型心绞痛短期结局的有用信息。然而，该模型识别高危患者的特异性较低。有必要开展关于肌钙蛋白T和C反应蛋白等新血清标志物在辅助识别高危患者方面的增量价值的未来研究。
