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[The problem of chronic refractory angina pectoris]

V B Chumburidze, N A Kharchilava, A V Aladashvili

    Georgian Medical News
    |April 12, 2005
    PubMed

    Insights

    Refractory angina pectoris significantly worsens prognosis and quality of life compared to stable angina. Many patients with refractory angina have diffuse coronary lesions and are unsuitable for interventions.

    Area of Science:

    • Cardiology
    • Internal Medicine

    Background:

    • Refractory angina pectoris (RAP) presents a poorer prognosis than stable angina.
    • Patients with RAP often exhibit diffuse coronary artery disease and numerous cardiac risk factors, leading to a diminished quality of life.
    • RAP patients are at higher risk for acute coronary events.

    Purpose of the Study:

    • To characterize patients with chronic stable angina, focusing on the prevalence and features of refractory angina pectoris.
    • To identify patient subgroups within chronic stable angina, including those with severe coronary artery disease, those managed with conventional therapy, and those undergoing revascularization.

    Main Methods:

    • A cohort of 36 patients (35-70 years) with chronic stable angina underwent comprehensive evaluation, including coronary angiography, ECG, echocardiography, stress testing, and laboratory analyses.
    • Patients were categorized based on coronary angiography findings, suitability for intervention, and response to therapy.
    • Refractory angina pectoris was defined as persistent ischemic symptoms despite optimal medical therapy in patients deemed unsuitable for interventional procedures.

    Main Results:

    • Out of 36 patients, 15 (41.6%) were classified as having refractory angina pectoris.
    • These refractory cases were characterized by ischemic heart disease symptoms persisting despite optimal medical management and unsuitability for interventional procedures due to factors like distal stenosis or diffuse arterial lesions.
    • Severe stenosis (80-95%) or occlusion of the left main coronary artery was identified in 5 patients. 10 patients without significant main coronary artery stenosis received conventional anti-ischemic therapy. 11 patients underwent revascularization (4 CABG, 7 PCI).

    Conclusions:

    • A significant proportion of patients with chronic stable angina may develop refractory angina pectoris, characterized by persistent symptoms and unsuitability for revascularization.
    • The findings highlight the challenges in managing refractory angina pectoris, emphasizing the need for further research into optimal therapeutic strategies for this patient group.

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