Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease
Clinical Experimental Research Laboratory, Department of Medicine, Östra University Hospital Göteborg, Sweden
revised 28 May 1996; accepted 9 September 1996.
Correspondence: Karl Andersen MD, Dept of Medicine, Östra University Hospital, S-415 85 Göteborg, Sweden
Abstract
AIMS: In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.
METHODS AND RESULTS: The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 µg. 1–1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P<0·05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P<0·05) and for patients with and without creatinine kinase-MB 
6 µg. 1–1 the event rate was 23% and 8% respectively (P<0·01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental.
CONCLUSIONS: Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.
Key Words: Unstable angina • risk • vectorcardiography • prognosis
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