Why the study?
Does the classification of unstable angina into crescendo versus non-crescendo types predict clinical outcomes in medically treated patients?
Does the classification of unstable angina into crescendo versus non-crescendo types predict clinical outcomes in medically treated patients?
Classifying unstable angina into crescendo and non-crescendo types is useful for assessing prognosis, as crescendo angina is associated with significantly higher rates of recurrent angina and myocardial infarction.
Crescendo angina may identify higher-risk medically treated patients; challenges uniform unstable angina prognosis assumptions but leaves open prospective validation.
One hundred patients with unstable angina who were treated medically were classified into 2 groups of non-crescendo and crescendo angina and reviewed regarding their clinical course for 24 months on the average. Thirty-four patients with non-crescendo angina had an occurrence of recurrent angina in 7 patients (21%), myocardial infarction in 2 (6%) and death in none, while 66 patients with crescendo angina had a significantly higher occurrence of recurrent angina in 29 (44%) and myocardial infarction in 14 (21%), p less than 0.05 in both angina and infarction. There were 4 (6%) deaths in patients with crescendo angina in spite of similar clinical backgrounds. Modern medical treatments of unstable angina include nitrates, beta blockers, calcium antagonists as well as antiplatelet and thrombolytic therapy. We conclude that our patients under active medical treatment have more favorable prognosis than once thought and that classification of unstable angina into non-crescendo and crescendo angina according to the early clinical course appears to be useful both for a selection of treatments and for an assessment of prognosis.
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Kanbara et al. (1983) studied this question.
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