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CLINICAL STUDIES

Clinical characteristics determining the mode of presentation in patients with acute coronary syndromes

Simon Kennon, MB, MRCP^*, Abdul Suliman, MB, MRCP, Peter K. MacCallum, MD, MRCPath, Kulasegaram Ranjadayalan, MPhil, MRCP, Paul Wilkinson, MB, MRCP and Adam D. Timmis, MD, FRCP^*

^* Department of Cardiology, Royal Hospitals Trust, London, United Kingdom
Department of Haematology, Royal Hospitals Trust, London, United Kingdom
Department of Cardiology, Newham Healthcare Trust, London, United Kingdom
Department of Environmental Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom

Manuscript received April 7, 1998; revised manuscript received July 27, 1998, accepted August 6, 1998.

Address for correspondence: Dr. Adam D. Timmis, Royal Hospitals Trust (London Chest Hospital), Bonner Road, London E2 9JX, United Kingdom

Objectives. The purpose of this study was to examine clinical characteristics of patients with acute coronary syndromes to identify factors that influence the mode of presentation.

Background. In acute coronary syndromes, presentation with myocardial infarction or unstable angina has major prognostic implications, yet clinical factors affecting the mode of presentation are not well defined.

Methods. A prospective cohort study was made of 1,111 patients with acute coronary syndromes. Baseline demographic, clinical and biochemical data were compared in groups with myocardial infarction (n = 633) and unstable angina (n = 478).

Results. The risk of myocardial infarction relative to unstable angina was increased by age >70 years (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.33 to 3.66), male gender (OR 1.56; CI 1.13 to 2.16) and cigarette smoking (OR 1.49; CI 1.09 to 2.03). A rise in admission creatinine from the 10th to the 90th centile of the distribution also increased the odds of myocardial infarction (OR 1.30; CI 1.05 to 1.94). Conversely, the risk of myocardial infarction relative to unstable angina was reduced by previous treatment with aspirin (OR 0.37; CI 0.27 to 0.52), hypertension (OR 0.64; CI 0.47 to 0.86) and previous acute coronary syndromes (OR 0.36; CI 0.26 to 0.51) and revascularization procedures (OR 0.36; CI 0.21 to 0.62).

Conclusions. The clinical presentation of acute coronary syndromes may be influenced by various factors that have the potential to influence the coagulability of the blood, the collateralization of the coronary circulation and myocardial mass. Myocardial infarction is favored by cigarette smoking, advanced age and renal impairment, while unstable angina is favored by treatment with aspirin, hypertension, previous revascularization and previous coronary syndromes.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   PAI-1 = plasminogen activator inhibitor

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