Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease

Eur Heart J. 1997 May;18(5):780-8. doi: 10.1093/oxfordjournals.eurheartj.a015343.


Aims: In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.

Methods and results: The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 microgram.l-1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P < 0.05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P < 0.05) and for patients with and without creatinine kinase-MB > or = 6 microgram.l-1 the event rate was 23% and 8% respectively (P < 0.01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental.

Conclusion: Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angina, Unstable / diagnosis
  • Angina, Unstable / mortality*
  • Angina, Unstable / physiopathology
  • Coronary Disease / diagnosis
  • Coronary Disease / mortality*
  • Coronary Disease / physiopathology
  • Creatine Kinase / blood*
  • Electrocardiography, Ambulatory / statistics & numerical data*
  • Female
  • Humans
  • Isoenzymes
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / physiopathology
  • Patient Admission / statistics & numerical data*
  • Predictive Value of Tests
  • Risk
  • Signal Processing, Computer-Assisted
  • Survival Rate
  • Sweden / epidemiology
  • Vectorcardiography / statistics & numerical data*


  • Isoenzymes
  • Creatine Kinase