Evolución hospitalaria y pronóstico actual de la angina inestable

Abstract

The prognosis of patients with unstable angina has improved in recent years resulting in a progressive reduction in hospital stay and treatment. The aim of this study was to know the current prognosis of patients with unstable angina in a non-selected population followed for up to 3 months. 478 consecutive patients with unstable angina were studied. They were treated following a strict protocol and a management policy guided by symptoms and the results of an exercise test or a pharmacological stress test performed before hospital discharge. The mean age was 66 +/- 11 years with 30% being females. Thirty-five percent had a prior history of myocardial infarction, 61% presented ischemic changes on the admission ECG, and 16% had elevation of the CK-MB plasma levels. An echocardiogram was performed in 80% of the patients, a stress test in 62%, coronary angiography in 51%, and a revascularization procedure in 27% of the patients. During hospitalization, the incidence of mortality or myocardial infarction, refractory angina or ischemic complications was of 3.6%, 11% and 13%, respectively. After hospital discharge and during a 3-month follow-up, the incidence of these complications was of 3.3%, 9% and 10% (NS compared to the in-hospital period). Overall, from the time of hospital admission to the 3-month follow-up, 4.2% of the patients died, 7% died or had an infarction, 20% had refractory angina, and 26% had some ischemic complication. The in-hospital prognosis of unstable angina is currently good. However, patients discharged from hospital after stabilization, present an important number of ischemic complications during the following 3 months, similar to that presented by all patients during the acute phase.