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Clinical predictors of unstable coronary lesion morphology.

We evaluated prospectively clinical and angiographic data in 400 patients, 200 with unstable and 200 with stable angina in order to determine which clinical markers could reliably predict unstable coronary artery lesions. Comparison of the angiogram of 200 patients with unstable and 200 with stable angina revealed a high-grade lesion (42% vs 23%, P < 0.0001), complex lesion morphology (49% vs 20%, P < 0.0001) and thrombus-containing lesions (7% vs 1%, P = 0.006) as typical findings in patients with unstable angina. A high-grade lesion and/or complex lesion (including thrombotic lesions but excluding total occlusion) was found in 61% of unstable and 34% of stable patients (P < 0.0001). Clinical features including the Braunwald classification of unstable angina were then evaluated by means of a multivariate approach with regard to their ability to predict the presence of unstable coronary artery lesions. Multivariate analysis revealed an abnormal ECG as the single most predictive clinical indicator of complex lesion morphology (P < 0.0001, odds ratio 4,2). The clinical presentation of recent onset of angina was highly predictive of a high grade lesion (P = 0.0003, odds ratio 3,2). The endpoint of a high-grade and/or a complex lesion was identified by an abnormal ECG (P = 0.0015, odds ratio 3,0) and recent onset angina (P = 0.0119, odds ratio 2,5). Thus, a high grade and/or complex lesion, typical of patients with unstable angina, was best identified by the clinical feature of recent onset angina and/or abnormal ECG changes.