Predicting the Course of Unstable Angina
Authors: Paul F. Kelly, Daniel J. Williford, Philip Greenland
Journal: Annals of Internal Medicine (1991)

Letters15 February 1991Predicting the Course of Unstable AnginaPaul F. Kelly, MD, Daniel J. Williford, PhD, MD, Philip Greenland, MDPaul F. Kelly, MDSearch for more papers by this author, Daniel J. Williford, PhD, MDSearch for more papers by this author, Philip Greenland, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-4-336 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: The recent article by Marmur and colleagues (1) suggests that quantitative tomographic exercise thallium scintigraphy is of value in identifying patients who are at risk for subsequent adverse events after medical stabilization and hospital care for unstable angina. We have several concerns about study design and data analysis that may invalidate the authors' conclusions.First, the methods used to follow the two study groups were not equal. The patients in the "adverse outcome" group clearly were sicker and were receiving more medication at baseline. Undoubtedly, this group received greater medical attention after hospitalization than did the "no...References1. Marmur J, Freeman M, Langer A, and Armstrong P. Prognosis in medically stabilized unstable angina: early holter ST-segment monitoring compared with predischarge exercise thallium tomography. Ann Intern Med. 1990;113:575-9. LinkGoogle Scholar2. Mulcahy R, Daly L, and Graham I. Unstable angina: natural history and determinants of prognosis. Am J Cardiol. 1981;48:525-8. CrossrefMedlineGoogle Scholar3. Mulcahy R, Awadhi A, and deBuitleor M. Natural history and prognosis of unstable angina. Am Heart J. 1985;109:753-8. CrossrefMedlineGoogle Scholar1. Marmur J, Freeman M, Langer A, and Armstrong P. Prognosis in medically stabilized unstable angina: early Holter ST-segment monitoring compared with predischarge exercise thallium tomography. Ann Intern Med. 1990;113:575-9. LinkGoogle Scholar2. Harrell F, Lee K, Califf R, Pryor D, and Rosati R. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143-52. CrossrefMedlineGoogle Scholar3. Work J, Ferguson J, and Diamond G. Limitations of a conventional logistic regression model based on left ventricular ejection fraction to predict coronary events following myocardial infarction. Am J Cardiol. 1989;64:702-7. CrossrefMedlineGoogle Scholar4. Diamond G. Future imperfect: the limitations of clinical prediction models and the limits of clinical prediction. J Am Coll Cardiol. 1989;14:12A-22A. CrossrefMedlineGoogle Scholar5. Diamond G. Stepwise transgression. Am J Cardiol. 1990;65:1047. CrossrefMedlineGoogle Scholar1. Marmur J, Freeman M, Langer A, and Armstrong P. Prognosis in medically stabilized unstable angina: early Holter ST-segment monitoring compared with predischarge exercise thallium tomography. Ann Intern Med. 1990;113:575-9. LinkGoogle Scholar2. Mulcahy R, Daly L, and Graham I. Unstable angina: natural history and determinants of prognosis. Am J Cardiol. 1981;48:525-8. CrossrefMedlineGoogle Scholar3. Mulcahy R, Awadhi A, and deBuitleor M. Natural history and prognosis of unstable angina. Am Heart J. 1985;109:753-8. CrossrefMedlineGoogle Scholar4. Smitherman T. Southwestern Internal Medicine Conference: unstable angina pectoris: the first half century: natural history, pathophysiology and treatment. Am J Med Sci. 1986;292:395-406. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Paul F. Kelly, MD; Daniel J. Williford, PhD, MD; Philip Greenland, MDAffiliations: University of Rochester Strong Memorial Hospital Rochester, NY 14642 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 February 1991Volume 114, Issue 4Page: 336-337KeywordsAdverse eventsExerciseHospitalizationsRadionuclide imagingThalliumUnstable angina ePublished: 1 December 2008 Issue Published: 15 February 1991 PDF downloadLoading ...