What clinical markers predict adverse outcomes in patients with unstable angina?

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.

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