Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study

doi:10.1136/bmj.38695.605440.AE

BMJ 2006;332:262-267 (4 February), doi:10.1136/bmj.38695.605440.AE (published 13 January 2006)

Research

Predicting prognosis in stable angina—results from the Euro heart survey of stable angina: prospective observational study

Caroline A Daly, clinical research fellow¹, Bianca De Stavola, senior lecturer in clinical epidemiology², Jose L Lopez Sendon, professor of cardiology³, Luigi Tavazzi, professor of cardiology⁴, Eric Boersma, clinical epidemiologist⁵, Felicity Clemens, medical statistician², Nicholas Danchin, cardiologist⁶, Francois Delahaye, cardiologist⁷, Anselm Gitt, cardiologist⁸, Desmond Julian, professor of cardiology⁹, David Mulcahy, consultant cardiologist¹⁰, Witold Ruzyllo, professor of cardiology¹¹, Kristian Thygesen, professor of cardiology¹², Freek Verheugt, professor of cardiology¹³, Kim M Fox, professor of cardiology¹, on behalf of the Euro Heart Survey Investigators

¹ Royal Brompton Hospital, London SW3 6NP, ² London School of Hygiene and Tropical Medicine, London, ³ Hospital Universitario Gregorio Maranon, Madrid, Spain, ⁴ Policlinico S Matteo, Pavia, Italy, ⁵ Erasmus Medical Centre, Rotterdam, Netherlands, ⁶ Hopital Europeen Georges Pompidou, Paris, France, ⁷ Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyons, France, ⁸ Herzzentrum Luwigshafen, Ludwigshafen, Germany, ⁹ University of Newcastle upon Tyne, Newcastle upon Tyne, ¹⁰ Adelaide and Meath incorporating National Children's Hospital, Dublin, Ireland, ¹¹ Institute of Cardiology, Warsaw, Poland, ¹² Aarhus University Hospital, Aarhus, Denmark, ¹³ University Medical Centre St Radboud, Nijmegen, the Netherlands

Correspondence to: C A Daly caroline.daly{at}imperial.ac.uk

Abstract

Objectives To investigate the prognosis associated with stableangina in a contemporary population as seen in clinical practice,to identify the key prognostic features, and from this to constructa simple score to assist risk prediction.

Design Prospective observational cohort study.

Setting Pan-European survey in 156 outpatient cardiology clinics.

Participants 3031 patients were included on the basis of a newclinical diagnosis by a cardiologist of stable angina with follow-upat one year.

Main outcome measure Death or non-fatal myocardial infarction.

Results The rate of death and non-fatal myocardial infarctionin the first year was 2.3 per 100 patient years; the rate was3.9 per 100 patient years in the subgroup (n = 994) with angiographicconfirmation of coronary disease. The clinical and investigativefactors most predictive of adverse outcome were comorbidity,diabetes, shorter duration of symptoms, increasing severityof symptoms, abnormal ventricular function, resting electrocardiogaphicchanges, or not having any stress test done. Results of non-invasivestress tests did not significantly predict outcome in the populationwho had tests done. A score was constructed using the parameterspredictive of outcome to estimate the probability of death ormyocardial infarction within one year of presentation with stableangina.

Conclusions A score based on the presence of simple, objectiveclinical and investigative variables makes it possible to discriminateeffectively between very low risk and very high risk patientsand to estimate the probability of death or non-fatal myocardialinfarction over one year.

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