Long-term risk factors from non-invasive evaluation of patients with acute chest pain, but without myocardial infarction
| Autor: | Per Fruergaard, Jan Madsen, Jacobsen Hl, Jeppe Launbjerg |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
Male Chest Pain medicine.medical_specialty Population Myocardial Infarction Chest pain Angina Pectoris Coronary artery disease Angina Risk Factors Internal medicine Humans Medicine cardiovascular diseases Myocardial infarction Risk factor education Aged Retrospective Studies ST depression education.field_of_study business.industry Middle Aged Prognosis medicine.disease Rate pressure product Acute Disease Multivariate Analysis Cardiology Regression Analysis Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Heart Journal. 16:30-37 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | The aims were to identify long-term risk factors for cardiac events, i.e. cardiac death and non-fatal acute myocardial infarction (AMI), and for development of angina pectoris among patients admitted with acute chest pain, but without confirmed AMI (non-AMI). A total of 257 consecutive non-AMI patients without other severe disease and below 76 years of age were included. Medical history and variables from the ECG while exercising, thallium scintigrams, Holter-monitoring, echocardiography and chest X-ray were recorded. The patients were followed for 7 years regarding cardiac death, non-fatal AMI and development of angina pectoris. The variables recorded at admission were compared to follow-up results by means of Uni- and multivariate analyses. During follow-up, 69 cardiac events, 44 cardiac deaths and 25 non-fatal AMIs occurred. The following variables provided independent prognostic information (relative risk factors with 95% confidence limits in brackets): age (1.05, 1.01–1.09), abnormal ECG at rest (2.81, 1.33–5.90), low increase in rate pressure product (4.57, 2.21–9.44), multiform premature ventricular beats (VPB) (2.61, 1.34–5.09) and transient thallium defects (2.64, 1.33–5.24). Sub-analysis of patients with and without a history of coronary artery disease (CAD) prior to admission identified the following risk factors: (1) Patients with previous CAD: abnormal ECG on admission, low increase in rate pressure product, ST depression during exercise. (2) Patients without previous CAD: abnormal ECG at rest, multiform VPBs and low increase in rate pressure product. Development of angina pectoris during follow-up of patients without previous CAD could not be predicted by any of the variables. The non-AMI population is a population at high risk for later cardiac events, but both high and low risk patients can be identified at the time of discharge. Variables from the medical history and the ECG on admission provide significant prognostic information, but the strongest independent information is collected from the ECG at rest and an exercise test. Low risk patients without signs of coronary artery disease are identified and can be reassured about their long-term excellent prognosis, whereas high risk patients should undergo further risk stratification, treatment and follow-up in order to improve the prognosis. |
| Databáze: | OpenAIRE |
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