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[Angiographic aspects of unstable angina]
Insights
Unstable angina patients are a diverse group. Angiographic findings like single-vessel disease in new-onset angina and multi-vessel disease in "in crescendo" angina suggest varied underlying coronary artery disease severity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Medicine
Background:
- Unstable angina pectoris (UAP) is a critical manifestation of coronary artery disease (CAD).
- Clinical presentation of UAP varies, including new onset and "in crescendo" patterns.
- The relationship between clinical UAP symptoms and angiographic CAD characteristics requires further elucidation.
Purpose of the Study:
- To compare angiographic findings in patients with new onset angina versus "in crescendo" angina.
- To determine if specific angiographic features correlate with distinct clinical presentations of unstable angina.
- To assess the heterogeneity of CAD in UAP patients.
Main Methods:
- Coronary angiography was performed on 194 patients with UAP (91 "in crescendo", 103 new onset).
- Angiographic data, including vessel disease extent and coronary collaterals, were analyzed.
- Ejection fraction was assessed, with a subgroup analysis excluding prior myocardial infarction.
Main Results:
- New onset angina was significantly associated with mono-vessel disease (p < 0.0001).
- "In crescendo" angina showed a higher prevalence of multi-vessel disease and coronary collaterals (p < 0.005).
- No significant difference in ejection fraction was initially observed, but "in crescendo" patients without prior infarction had lower ejection fraction (p < 0.01).
Conclusions:
- Patients with unstable angina represent a heterogeneous group.
- Clinical symptom severity does not reliably correlate with the degree of angiographic coronary lesions.
- Distinct angiographic patterns exist for different UAP presentations, impacting patient stratification.
Abstract:
One-hundred and ninety-four patients with unstable angina pectoris (91 "in crescendo" angina and 103 new onset angina) underwent coronary angiography. The angiographic data from both groups were compared in order to discover whether angiographic aspects were related to the various clinical symptoms of coronary artery disease. Patients with recent onset angina had a significant increase (p less than 0.0001) of mono-vessel disease, whereas multi-vessel disease was prevalent in patients with "in crescendo" angina pectoris. Higher prevalence of coronary collaterals was observed in patients with "in crescendo" angina (p less than 0.005). No significant difference was observed in ejection fraction of the two groups. A further analysis was performed in 100 patients with unstable angina pectoris but without prior myocardial infarction (42 "in crescendo" angina and 58 recent onset angina). Also in these patients were found the same results; with the exception of ejection fraction which was more slight in patients with "in crescendo" angina (p less than 0.01). These data confirm that patients with unstable angina are an heterogeneous group in which comparison is unreliable and that the severity of clinical symptoms is not related to the degree of angiographic coronary lesions.