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[Spontaneous angina with ST elevation. Significance and prognostic value]
La Nouvelle Presse Medicale
|November 29, 1975
Summary
This study differentiates spontaneous angina with transient ST elevation (T ST E) into two groups: those without myocardial infarct (MI) and those with MI. The former indicates severe angina requiring surgery, while the latter signifies a poorer prognosis unrelated to Prinzmetal angina.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Spontaneous angina with transient ST elevation (T ST E) and normal enzyme levels presents diagnostic challenges.
- Distinguishing between T ST E with and without myocardial infarct (MI) is crucial for prognosis and treatment.
- Previous classifications may not adequately address the nuances of T ST E in different clinical contexts.
Purpose of the Study:
- To analyze and differentiate 36 cases of spontaneous angina with T ST E based on the presence or absence of myocardial infarct (MI).
- To evaluate the prognostic implications and optimal management strategies for each group.
- To clarify the significance of T ST E in relation to MI and its distinction from Prinzmetal angina.
Main Methods:
- Retrospective analysis of 36 patients presenting with spontaneous angina and transient ST elevation.
- Classification of patients into two groups: Group A (no MI) and Group B (with MI).
- Clinical data, electrocardiographic findings, cardiac enzyme levels, coronary angiography, and patient outcomes were reviewed.
Main Results:
- Group A (16 cases) showed severe prognosis with rhythm disturbances (10/16) and high rates of surgical stenosis (12/14), indicating severe angina often requiring surgery (95%).
- Group B (20 cases) presented with higher incidence of cardiac failure (15/20) and widespread coronary lesions not amenable to bypass.
- Prognosis in Group B was severe, with MI extension or sudden death in medically treated patients (6/17), similar to general relapse patterns.
Conclusions:
- Spontaneous angina with T ST E and no MI signifies severe angina, often requiring surgical intervention, similar to Prinzmetal angina.
- T ST E in the presence of MI (Group B) does not carry the same prognostic weight as in Prinzmetal angina and indicates a severe underlying condition.
- Patients with progressive MI relapses accompanied by T ST E should not be misclassified as having Prinzmetal angina.