Although left ventricular function and the extent of CAD ultimately determine long-term prognosis, recognition of certain clinical markers in patients with unstable angina is of value in defining management strategies:
• Recurrence of chest pain within 48 hours after admission carries a reduction in survival by 20% in patients with crescendo angina.
• ECG changes consistent with ischemia on admission predict recurrence of ischemia, myocardial infarction, or need for revascularization in 80% of patients.
• Postinfarction angina within 24 hours confers a 10% reduction in survival during the next year compared to asymptomatic patients.
• Rapidly accelerating symptoms of angina are the main determinant of prognosis in new-onset angina.
Aggressive medical management and early coronary angiography are indicated in these patient subsets.