Incidence and follow-up of Braunwald subgroups in unstable angina pectoris
AJ van Miltenburg-van Zijl,
ML Simoons,
RJ Veerhoek,
and
PM Bossuyt
Thoraxcenter Erasmus University, Rotterdam, The Netherlands.
OBJECTIVES. This study was performed to establish the prognosis of patients with unstable angina within the subgroups of the Braunwald classification. BACKGROUND. Among many classifications of unstable angina, the Braunwald classification is frequently used. However, the incidence and risk for each subgroup in clinical practice have not been established. METHODS. Prospective data for 417 consecutive patients admitted for suspected unstable angina were analyzed. Patients were classified according to Braunwald criteria and followed up for 6 months. Survival, infarct-free survival and infarct-free survival without intervention are reported for each class. RESULTS. After in-hospital observation the final diagnosis was acute myocardial infarction in 26 patients (6%), noncoronary chest pain in 109 (26%) and definite unstable angina in 282 (68%). Recurrence of chest pain was significantly different for the different severity classes (28%, 45% and 64% for classes I [accelerated angina], II [subacute angina at rest] and III [acute angina at rest], respectively) but not for clinical circumstances (49% and 53% for classes B [primary unstable angina] and C [postinfarction unstable angina], respectively). Six-month and infarct-free survival (96% and 88%, respectively) were not significantly different between severity classes but were significantly different (p = 0.01) between classes B (97% and 89%) and C (89% and 80%). Infarct-free survival without intervention was best for class II (72%), intermediate for class I (53%) and worst for class III (35%). In multivariate analysis, elderly age, male gender, hypertension, class C and maximal (intravenous) therapy were independent predictors for death; elderly age and class C for infarct-free survival; and male gender, class III, class C, electrocardiographic changes and maximal therapy were associated with infarct-free survival without intervention. CONCLUSIONS. Braunwald classification is an appropriate instrument to predict outcome. Risk stratification by these criteria provides a tool for patient selection in clinical trials and for evaluation of treatment strategies.
This article has been cited by other articles:

|
 |

|
 |
 
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al.
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J. Am. Coll. Cardiol.,
August 14, 2007;
50(7):
e1 - e157.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al.
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Eur. Heart J.,
July 1, 2007;
28(13):
1598 - 1660.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B Lagerqvist, E Diderholm, B Lindahl, S Husted, F Kontny, E Stahle, E Swahn, P Venge, A Siegbahn, and L Wallentin
FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease
Heart,
August 1, 2005;
91(8):
1047 - 1052.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G A Large
Contemporary management of acute coronary syndrome
Postgrad. Med. J.,
April 1, 2005;
81(954):
217 - 222.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. W. Chiu, N. M. C. So, W. W. M. Lam, K. Y. Chan, and J. E. Sanderson
Combined First-Pass Perfusion and Viability Study at MR Imaging in Patients with Non-ST Segment-Elevation Acute Coronary Syndromes: Feasibility Study
Radiology,
March 1, 2003;
226(3):
717 - 722.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. S. Sabatine and E. M. Antman
The thrombolysis in myocardial infarction risk score in unstable angina/non-ST-segment elevation myocardial infarction
J. Am. Coll. Cardiol.,
February 19, 2003;
41(4_Suppl_S):
89S - 95S.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C Miller, K Lipscomb, and N Curzen
Are district general hospital patients with unstable angina at a disadvantage?
Postgrad. Med. J.,
February 1, 2003;
79(928):
93 - 98.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo
Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Eur. Heart J.,
December 1, 2002;
23(23):
1809 - 1840.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C.V Patil, E Nikolsky, M Boulos, E Grenadier, and R Beyar
Multivessel coronary artery disease: current revascularization strategies
Eur. Heart J.,
July 2, 2001;
22(14):
1183 - 1197.
[PDF]
|
 |
|

|
 |

|
 |
 
A. G. G. Turpie and E. M. Antman
Low-Molecular-Weight Heparins in the Treatment of Acute Coronary Syndromes
Arch Intern Med,
June 25, 2001;
161(12):
1484 - 1490.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
British Cardiac Society Guidelines and Medical Pra and Royal College of Physicians Clinical Effectiveness
Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation
Heart,
February 1, 2001;
85(2):
133 - 142.
[Full Text]
|
 |
|

|
 |

|
 |
 
P. Agostoni, G. G.L Biondi-Zoccai, E. R. Ferreiros, C. P. Boissonnet, R. Pizarro, P. F. Garcia Merletti, G. Corrado, A. Cagide, and O. O. Bazzino
Prognostic Value of C-Reactive Protein in Unstable Angina Response
Circulation,
November 28, 2000;
102
(22):
e177 - e177.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. E. Calvin, L. W. Klein, E. J. VandenBerg, P. Meyer, and J. E. Parrillo
Validated risk stratification model accurately predicts low risk in patients with unstable angina
J. Am. Coll. Cardiol.,
November 15, 2000;
36(6):
1803 - 1808.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al.
ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina)
J. Am. Coll. Cardiol.,
September 1, 2000;
36(3):
970 - 1062.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo
Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology
Eur. Heart J.,
September 1, 2000;
21(17):
1406 - 1432.
[PDF]
|
 |
|

|
 |

|
 |
 
C. W. Hamm and E. Braunwald
A Classification of Unstable Angina Revisited
Circulation,
July 4, 2000;
102(1):
118 - 122.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K.M Akkerhuis, J.W Deckers, E Boersma, R.A Harrington, J Stepinska, K.W Mahaffey, R.G Wilcox, A.M Lincoff, M Keltai, E.J Topol, et al.
Geographic variability in outcomes within an international trial of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes. Results from PURSUIT
Eur. Heart J.,
March 1, 2000;
21(5):
371 - 381.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
J. A. Ambrose and G. Dangas
Unstable Angina: Current Concepts of Pathogenesis and Treatment
Arch Intern Med,
January 10, 2000;
160(1):
25 - 37.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M van den Brand, G.J Laarman, P.G Steg, I De Scheerder, G Heyndrickx, K Beatt, J Kootstra, and M.L Simoons
Assessment of coronary angiograms prior to and after treatment with abciximab, and the outcome of angioplasty in refractory unstable angina patients. Angiographic results from the CAPTURE trial
Eur. Heart J.,
November 1, 1999;
20(21):
1572 - 1578.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al.
ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions
J. Am. Coll. Cardiol.,
May 1, 1999;
33(6):
1756 - 1824.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. M. Zaacks, P. R. Liebson, J. E. Calvin, J. E. Parrillo, and L. W. Klein
Unstable angina and non-Q wave myocardial infarction: does the clinical diagnosis have therapeutic implications?
J. Am. Coll. Cardiol.,
January 1, 1999;
33(1):
107 - 118.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Klootwijk, S. Meij, R. Melkert, T. Lenderink, and M. L. Simoons
Reduction of Recurrent Ischemia With Abciximab During Continuous ECG-Ischemia Monitoring in Patients With Unstable Angina Refractory to Standard Treatment (CAPTURE)
Circulation,
October 6, 1998;
98(14):
1358 - 1364.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N P Curzen, D J Patel, M Kemp, J Hooper, C J Knight, D Clarke, C Wright, and K M Fox
Can C reactive protein or troponins T and I predict outcome in patients with intractable unstable angina?
Heart,
July 1, 1998;
80(1):
23 - 27.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
H. Toss, B. Lindahl, A. Siegbahn, L. Wallentin, and f. t. F. S. Group
Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease
Circulation,
December 16, 1997;
96(12):
4204 - 4210.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
M. Galvani, F. Ottani, D. Ferrini, J. H. Ladenson, A. Destro, D. Baccos, F. Rusticali, and A. S. Jaffe
Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina
Circulation,
April 15, 1997;
95(8):
2053 - 2059.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
A. A. Passer, M. J. Garcia, P. S. Pollack, D. H. Wiener, J. B. Gill, J. A. Cairns, and R. S. Roberts
Myocardial Ischemia Detected by Ambulatory Monitoring after Myocardial Infarction
N. Engl. J. Med.,
June 6, 1996;
334(23):
1545 - 1546.
[Full Text]
|
 |
|

|
 |

|
 |
 
BRAUNWALD ANGINA CLASS PREDICTS ADVERSE OUTCOMES
Journal Watch (General),
May 19, 1995;
1995(519):
8 - 8.
[Full Text]
|
 |
|
|