Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study.

Royal Brompton Hospital, London SW3 6NP.
BMJ (online) (Impact Factor: 16.38). 03/2006; 332(7536):262-7. DOI: 10.1136/bmj.38695.605440.AE
Source: PubMed

ABSTRACT To investigate the prognosis associated with stable angina in a contemporary population as seen in clinical practice, to identify the key prognostic features, and from this to construct a simple score to assist risk prediction.
Prospective observational cohort study.
Pan-European survey in 156 outpatient cardiology clinics.
3031 patients were included on the basis of a new clinical diagnosis by a cardiologist of stable angina with follow-up at one year.
Death or non-fatal myocardial infarction.
The rate of death and non-fatal myocardial infarction in the first year was 2.3 per 100 patient years; the rate was 3.9 per 100 patient years in the subgroup (n = 994) with angiographic confirmation of coronary disease. The clinical and investigative factors most predictive of adverse outcome were comorbidity, diabetes, shorter duration of symptoms, increasing severity of symptoms, abnormal ventricular function, resting electrocardiogaphic changes, or not having any stress test done. Results of non-invasive stress tests did not significantly predict outcome in the population who had tests done. A score was constructed using the parameters predictive of outcome to estimate the probability of death or myocardial infarction within one year of presentation with stable angina.
A score based on the presence of simple, objective clinical and investigative variables makes it possible to discriminate effectively between very low risk and very high risk patients and to estimate the probability of death or non-fatal myocardial infarction over one year.

Download full-text


Available from: Anselm K Gitt, Aug 09, 2015
  • Source
    • "Fatigue is a non-specific symptom that is challenging for symptom management in CHD patients. The symptom of fatigue can be experienced in a patient who is having sleep difficulties or is deconditioned, but can also be experienced when a patient is depressed (Casillas et al. 2006). Depression is common in patients with CHD and is an independent predictor of poorer HRQOL (Sullivan et al. 2001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper reports findings of a study to examine the independent contribution of chest pain, fatigue and dyspnoea to health-related quality of life in people with chronic stable angina. People with chronic stable angina experience poorer quality of life in multiple areas including physical and emotional health. Emerging evidence suggests the presence of concomitant symptoms yet there are no systematic studies examining the impact of symptom clusters on quality of life in people with chronic angina. Outpatients (n = 134), recruited over a 16-month period in 2000 and 2001, with confirmed coronary heart disease and chronic angina completed reliable and valid questionnaires measuring chest pain frequency, fatigue, dyspnoea and quality of life. The data have contemporary relevance because despite changes in treatment of coronary heart disease, chronic angina remains prevalent worldwide. Hierarchical multiple linear regression was used to examine the symptom cluster of chest pain frequency, fatigue and dyspnoea in predicting quality of life. The sample was predominantly white (74·6%), men (59·7%) with a mean age of 63·4 (sd 12·12) years. Controlling for age, gender, social status and co-morbidities, the symptom cluster of chest pain frequency, dyspnoea and fatigue accounted for a statistically significant increase in unadjusted R² (F of Δ, P < 0·05) for the models predicting physical limitation (R² Δ 24·1%), disease perception (R² Δ 24·6%), Short Form-36 Physical Component Score (R² Δ 24·3%) and Mental Component Score (R² Δ 07·0%). Symptom assessment and management of people with chronic stable angina should involve multiple symptoms. Greater fatigue predicted poorer quality of life in multiple areas. As a possible indicator of depression, it warrants further assessment and follow-up.
    Journal of Advanced Nursing 02/2011; 67(5):1000-11. DOI:10.1111/j.1365-2648.2010.05564.x · 1.69 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Die stabile Angina pectoris ist die häufigste Form der koro-naren Herzerkrankung, sie tritt bei ca. 50 % aller KHK-Patien-ten als Erstmanifestation auf. Die Prävalenz liegt bei Männern zwischen 40 und 55 Jahren bei 2–5 %, während sie bei 65-bis 75jährigen bei 11–20 % gelegen ist. Bei Frauen zeigt eine re-zente Studie aus Finnland, daß entgegen bisherigen Ansichten die Inzidenz der AP den Männern ähnlich ist. In Österreich wird mit ca. 250.000 Personen mit chronisch-stabiler Angina pectoris gerechnet. Im Zeitalter der Interven-tionen muß auch festgehalten werden, daß bei vielen Patienten trotz PCI-Stenting eine Angina pectoris persisiert (ca. in 20 % der Fälle nach PCI). Die Einführung der aortokoronaren Bypass-Operation (CABG) und noch mehr der perkutanen Koronarinterventionen (PCI/ Stenting) hat die Behandlung der chronisch stabilen Angina in der Praxis entscheidend verändert. Revaskularisationsmaß-nahmen können die Symptome (Angina) und Lebensqualität verbessern und in besonderen High-Risk-Gruppen, wie bei Hauptstammstenose, Dreigefäßerkrankung und proximaler LAD-Stenose, auch die Prognose verbessern. Es gibt jedoch keine EBM-Daten, die den prognostischen Wert einer "routi-nemäßigen" PCI bei Patienten mit KHK und stabiler Angina pectoris belegen.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary Conservative versus invasive strategy in stable angina: changing paradigms and perception Percutaneous coronary intervention (PCI) is effective at reducing angina in patients with symptomatic coronary artery disease and at reducing mortality in patients who have acute myocardial infarction with ST-segment eleva- tion and in those who have high-risk acute coronary syndromes without ST-segment ele- vation. Such success has often been extrapo- lated in support of more widespread use of PCI in patients with stable coronary artery disease in hopes of reducing subsequent cardiac events. In 2004, more than one million coro- nary stent procedures were performed in the United States, and recent registry data indi- cate that approximately 85% of all PCI proce- dures are undertaken electively in patients with stable coronary artery disease. Whereas PCI reduces the incidents of death and my- ocardial infarction in patients who present with acute coronary syndromes, similar bene- fit has not been shown in patients with stable coronary artery disease. Whether primary in- tervention with PCI is the treatment of choice
Show more