Risk Stratification in Unstable Angina Prospective Validation of the Braunwald Classification JAMA, January 11, 1995-Vol.273,No. 2

Study summary : validation cohort of 393 consecutive patients, admitted for unstable angina, and followed prospectively for in-hospital complications including MI and death main outcome measures accounted for major cardiac complications including death, myocardial infarction, CHF, cardiogenic shock, and severe ventricular arrhythmias Risk Stratification in Unstable Angina JAMA, January 11, 1995-Vol.273,No. 2 Four clinical factors which are used in the Braunwald classification predicted major complications: (1) MI within less than 14 days (2) need for IV nitroglycerin (3) lack of  blocker/CCB prior to admission (4) baseline ST depression *diabetes and age were also significant predictors, as determined in the analysis*

Classification of angina as proposed by Braunwald A. In the presence of an B.No exacerbating C. Within Extracardiac condition Extracardiac 2 weeks that intensifies Condition after M.I. Severity myocardial infarction I. New onset of severe or accelerated angina; no rest pain II. Angina at rest within past month, but not within preceding 48 hours III. Angina at rest within last 48 hours IA IIA IIIA IBIC IIBIIC IIIBIIIC JAMA, January 11, 1995-Vol.273,No. 2

Comparison between all complicated and uncomplicated patients with unstable angina Complicated Uncomplicated Number (%) Number (%) CHARACTERISTIC (N=77) (N=316) P rest pain 62 (81) 248 (79) 0.77 progressive angina 15 (20) 65 (21) 0.82 baseline ST depression 22 (29) 49 (16).007 positive family history 31 (40) 102 (32) 0.18 hypertension 49 (64) 188 (60) 0.51 elevated cholesterol 26 (34) 120 (38) 0.49 diabetes* 42 (55) 108 (34).001 previous MI 33 (43) 98 (31) 0.05 post M I (<14 days) 11 (14) 11 (4).001 requiring IV NTG 33 (43) 82 (26).003  blocker/rate CCB 8 (10) 82 (26).004 history of smoking 42 (55) 121 (38).009 Aspirin use 68 (88) 288 (91) 0.45 age* 67 (15) 61 (17).004 JAMA, January 11, 1995-Vol.273,No. 2

Comparison between complicated (MI/ death) and Uncomplicated patients with UAP Complicated Uncomplicated Number (%) Number (%) CHARACTERISTIC (N=30) (N=363) P rest pain 25 (83) 286 (79) 0.57 baseline ST depression 12 (40) 59 (16).001 positive family history 14 (47) 119 (33) 0.12 hypertension 21 (40) 216 (60) 0.26 elevated cholesterol 13 (43) 133 (37) 0.48 diabetes* 18 (60) 132 (36) 0.01 previous MI 14 (47) 117 (32) 0.11 post M I (<14 days) 6 (20) 16 (4).001 requiring IV NTG 14 (47) 101 (28) 0.03  blocker/rate CCB 2 (7) 88 (24) 0.03 history of smoking 16 (53) 147 (41) 0.18 exacerbating condition 5 (17) 34 (9) 0.20 age* 68 (16) 62 (17) 0.06 JAMA, January 11, 1995-Vol.273,No. 2

Predictors of all major cardiac complications using Braunwald Factors’ alone 95% Odds Confidence VariableRatio Interval P Post M I (< 14 days) Requiring IV NTG on admission No beta-blocker or rate lowering CCB Baseline ST depression Constant JAMA, January 11, 1995-Vol.273,No. 2

Predictors of all major cardiac complications using Braunwald criteria, diabetes and age 95% Odds Confidence VariableRatio Interval P Post M I (< 14 days) Requiring IV NTG on admission No beta-blocker or rate lowering CCB Baseline ST depression Diabetes Mellitus Incremental decade of age Constant JAMA, January 11, 1995-Vol.273,No. 2

Predictors of myocardial infarction and death 95% Odds Confidence VariableRatio Interval P Post M I (< 14 days) No beta-blocker or rate lowering CCB Baseline ST depression Diabetes Mellitus Constant JAMA, January 11, 1995-Vol.273,No. 2