Correlation of Clinical and Electrocardiographic Variables with Coronary Lesions in Unstable Angina Pectoris

The relation of clinical and electrocardiographic variables to the severity of coronary lesions in unstable angina was studied in 84 men and 8 women, aged thirty-nine to seventy-five, who were subjected to coronary arteriography within two weeks. Eighty- seven patients (94.6%) had significant stenosis (50% of the diameter) of at least one vessel, whereas 5 (5.4%) had normal coronary arteries. Eleven (12%) had one-vessel disease, 13 (14%) had two-vessel, and 63 (68.5%) had three-vessel disease. Twelve (13%) had also significant left main stem stenosis. Except for 1 patient with artificial pacemaker, three-vessel and/or left main stem disease was present in 20 (100%) patients with ST segment deviation ≥ 0.2mV as compared with 20 of 36 patients (55.5%) with ST segment deviation of 0.1-0.19 mV and 24 of the 35 (68.6%) with no additional ECG changes or with T wave inversion only (P < 0.005). The direction of ST segment deviation (elevation or depression) made no difference. Preexisting angina or infarction was associated with three-vessel disease and/or left main stem disease in 74.1% and 81.4%, respectively, as compared with 45.5% (P=0.05) of the patients with angina of recent onset. Pain at rest persisting for more than forty-eight hours was associated with three-vessel and/or main stem disease in 93.1% of the patients as compared with 60.3% of patients in whom rest angina subsided within forty-eight hours (P < 0.01) . In the multivariable analysis the duration of unstable angina (P=0.010), the degree of the ST segment deviation (P=0.006), age (P=0.011), and possibly preexisting myocardial infarction (P=0.076) were associated with the number of the diseased vessels. In contrast, sex (P=0.370), blood pressure ≥ 160/90 mmHg (P=0.619), smoking (P=0.249), diabetes mellitus (P=0.797), and preexisting ischemic heart disease (P=0.509) were not significant factors in the extent of the coronary lesions.