Acute coronary insufficiency. An urgent surgical condition

Clinical and coronary arteriographic features and outcome of recent onset unstable angina

Fifty consecutive patients (43 male and seven female; mean age 51.8 years) with recent onset angina (24.6% of all admissions for unstable angina during a 1-year period) underwent coronary arteriography. Most patients (96.8%) presented with severe angina (Canadian Cardiovascular Society Class III-IV) with admission ECG changes of myocardial ischemia in 46%. Echocardiography (within 2 days of admission) showed normal left ventricular function (LVEF > 50%) in 80% and mild or moderate impairment (LVEF 35-49%) in 12% of patients. Segmental wall motion abnormalities were noted in a small number (12.9%). Coronary angiography revealed significant (> or = 70% diameter stenosis) disease in one vessel in 14 (28%), in two vessels in seven (14%), three vessels in 22 (44%) and no disease in seven (14%) patients. Significant left main stenosis (> or = 50% diameter stenosis) was present in two (5%) patients. Left anterior descending artery was more commonly involved (66%) as compared to the other arteries. A significantly higher incidence of multivessel disease was observed in patients with diabetes mellitus (P < 0.003) and in smokers (P < 0.04). Multiple coronary artery involvement was more common in patients with three or more risk factors for coronary artery disease (P < 0.005). In-hospital non fatal myocardial infarction occurred in three (6%) patients. During follow-up (average 13 +/- 1.28 months) 30 (60%) patients underwent coronary artery bypass surgery, 13 (26%) required coronary angioplasty while seven (14%) were managed by drugs alone with no further mortality and significant symptomatic relief. Patients with recent onset angina, in our setting, frequently have severe multiple vessel coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and coronary angiographic findings of 400 Korean adults with coronary artery disease

The clinical and angiographic findings of Korean adults with coronary artery disease (obstructions exceeding 50% of the internal diameter of the lumen of one or more major coronary arteries) were studied in 400 of 670 patients on whom selective cinecoronary arteriograms were performed at the Department of Internal Medicine, Yonsei University, College of Medicine between January 1981 and August 1986. Among the 400 cases with significant coronary atherosclerosis, a clinical diagnosis of unstable angina (including new-onset angina in which angina developed within 3 months) was made in 45.8%, stable angina in 16.0%, variant angina, 3.7%, acute myocardial infarction, 17.3%, and old myocardial infarction, 17.3%. Single vessel disease was more prevalent in the group with unstable angina (53%) than with stable angina (47%). The incidence of multi-vessel involvement was low in patients with acute myocardial infarction (46%), in contrast to a much higher incidence in the group with old myocardial infarction with angina (76%). An average of 2.2 lesions resulting in at least 50% luminal narrowing of the major arteries was found per patient. The anterior descending coronary artery was involved more frequently than other vessels.

Unstable angina pectoris of new onset: a prospective clinical and arteriographic study of 75 patients

Seventy-five patients with unstable angina pectoris of new onset (defined as of less than 90 days' duration) were prospectively evaluated in terms of clinical and arteriographic findings. In all patients the angina was considered unstable in terms of ease of provocation of anginal attacks and frequency of occurrence of attacks. Sixty patients had significant obstruction of at least one coronary artery, whereas 15 had insignificant disease (less than 70 percent arterial narrowing) or normal coronary arteries. Thirty-one patients (52 percent) had single vessel coronary disease, 11 (18 percent) had double vessel disease and 9 (15 percent) had triple vessel disease; the remaining 9 (15 percent) had left main coronary artery disease, either alone or in association with other vessel involvement. Of the 31 patients with single vessel disease, 24 (77 percent) had stenosis of the left anterior descending artery. The patients with single vessel disease did not differ from the patients with multivessel involvement with respect to risk factors or clinical presentation. It is concluded that patients with unstable angina of new onset have an unusually large incidence of single vessel coronary artery disease predominantly involving the left anterior descending coronary artery. Thus, these patients constitute a unique subset of patients with angina pectoris.

Clinical spectrum of "unstable angina"

In order to determine the natural evolution of different clinical types of "unstable angina", 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow-up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III--IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24). Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p less than 0.001 for mortality and p less than 0.03 for AMI incidence respectively). We conclude that it is clinically possible to identify different groups within the so-called unstable angina. Such a division not only allows for the creation of more homogeneous groups, but it contributes to a more rational therapeutic approach and also permits identification of high risk prodromes of greater complications, such as myocardial infarction or sudden death.