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  • Title: [Identification of patients at high risk in the initial evaluation of unstable angina. Clinical importance of electrocardiogram, Holter and biochemical markers in myocardial lesions].
    Author: López de Sá E.
    Journal: Rev Esp Cardiol; 1999; 52 Suppl 1():97-106. PubMed ID: 10364819.
    Abstract:
    Beneath the expression of unstable angina are joined an heterogeneous group of patients with different prognosis. In the initial presentation it is difficult to differentiate from non-Q wave myocardial infarction. The present review attempts to establish the relative importance of the clinical presentation, the electrocardiogram, the Holter monitoring and the biochemical markers of myocardial damage for risk stratification of these patients. The clinical factors related with prognosis are the general risk factors related to the prognosis in other presentations of the ischemic heart disease as the presence of previous myocardial infarction, age, presence of heart failure or left ventricular dysfunction, diabetes and peripheral vascular disease. The electrocardiogram is the most helpful method for risk stratification of unstable angina patients, especially depression. The continuous monitoring of the ST-segment through Holter monitoring constitutes an important investigation area, but presumably it can not be recommended as routine utilisation yet in the managing of this sort of patients. The rising of cardiac troponins T or I constitute other important risk marker. Possibly three different risk groups could be established: a) patients at low risk, those with normal electrocardiogram or only negative T-waves and normal cardiac troponins; b) intermediate risk, those patients with rising of cardiac troponins and normal electrocardiogram or electrocardiogram with ST-segment depression and normal cardiac troponins, and c) high risk, corresponding to the patients with rising of cardiac troponins and electrocardiogram with ST-segment depression.
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