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J Am Coll Cardiol, 2001; 37:2053-2058 © 2001 by the American College of Cardiology Foundation |
a Division of Cardiovascular Diseases, Mayo Foundation, Rochester, Minnesota, USA
Manuscript received July 10, 2000; revised manuscript received February 16, 2001, accepted March 1, 2001.
Reprint requests and correspondence: Dr. Verghese Mathew, Mayo Clinic, Rm 4-523 Mary Brigh, 200 First Street SW, Rochester, Minnesota 55905
mathew.verghese{at}mayo.edu
OBJECTIVES
We sought to determine whether clinical risk stratification correlates with the angiographic extent of coronary artery disease (CAD) in patient with unstable angina.
BACKGROUND
The Agency for Health Care Policy and Research (AHCPR) guidelines stratify patients with unstable angina according to short-term risk of myocardial infarction or death. Whether these guidelines are useful in predicting the extent of CAD is unknown.
METHODS
All residents of Olmsted County, Minnesota, undergoing emergency department evaluation from January 1, 1985 through December 31, 1992 for unstable angina without a history of prior coronary artery bypass grafting, and who underwent early angiography (within seven days of presentation) were classified into low, intermediate and high risk subgroups based on AHCPR criteria.
RESULTS
Seven hundred ninety-five patients underwent early angiography: 159 high risk, 572 intermediate risk and 64 low risk patients. Logistic regression analysis demonstrated that low risk patients had a greater likelihood of normal or mild CAD relative to intermediate risk (odds ratio [OR], 4.67; 95% confidence interval [CI], 2.70–8.06; p < 0.001) and high risk (OR, 11.1; 95% CI, 5.71–22.2; p < 0.001). Significant 1-, 2-, 3-vessel coronary disease or left main coronary disease was more likely in high relative to low risk (OR, 8.09; 95% CI, 4.22–15.5; p < 0.001), intermediate relative to low risk (OR, 4.11; 95% CI, 2.34–7.22; p < 0.001), and high relative to intermediate risk (OR, 1.97; 95% CI, 1.31–2.96; p = 0.0012).
CONCLUSIONS
Among patients with unstable angina undergoing early coronary angiography, risk stratification according to the AHCPR guidelines correlates with the angiographic extent of CAD.
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