Prognosis

A clinical prediction rule may help indicate patients at risk of death or infarction

b	risk group	intractable angina at discharge	MI at discharge	death at discharge
Ia	acceleration of previously chronic stable angina without new ECG changes	0.0%	2.7%	0.0%
Ib	acceleration of previously chronic stable angina with new ECG changes	3.5%	5.6%	0.0%
II	exertional angina of new onset	3.9%	5.7%	0.0%
III	new-onset resting angina	11%	8.8%	1.5%
IV	protracted chest pain > 20 minutes duration per episode with persistent abnormalities of subendocardial ischaemia	19%	18%	6.4%

Patients are at increased risk of dying, having a myocardial infarction or requiring revascularisation with: 

• male sex ^a  
• increasing age ^{a b}
• diabetes mellitus ^a
• hypertension ^b
• a myocardial infarction within previous 14 days ^a or angina at rest within previous 48 hours ^a
• history of or current congestive heart failure ^b
• tachycardia or low blood pressure on admission ^b
• ST depression on ECG ^{a b}, particularly within 24 h of admission ^b
• elevated troponin ^{a b} 
• elevated homocysteine levels ^a
• requirement for IV nitrates on admission ^a
• not on a beta-blocker or rate-lowering calcium-channel blocker ^a
• maximal antianginal therapy ^b

Exercise ECG

Sum the following:

• duration of exercise in minutes
• minus (5 x maximal net ST-segment deviation during or after exercise, mm)
• minus (4 x treadmill angina index)

Treadmill angina index

Exercise ECG score

In addition look for

• abnormal heart rate recovery (< 12- 18 beats/min fall after 1 minute of recovery) ^a
• resting tachycardia ^a

Angioplasty

The risk of dying following angioplasty is increased with ^a

• increasing age
• hypertension
• diabetes mellitus
• previous myocardial infarction
• ejection fraction < 50%
• feeling disabled