[Long-term course over three years in a patient with unstable angina pectoris]

The long-term follow up in 48 patients with unstable angina pectoris was analyzed retrospectively. All patients were hospitalized in a coronary care unit during the acute phase and responded favourably to a medical regimen consisting of nitrates in 45 patients, betablockers in 23, calcium channel blocking agents in 22 and i.v. nitroglycerin in 12. 30 patients (group 1) responded promptly to oral medication with one or a combination of two drugs, whereas in 18 patients a combination of at least three drugs or intravenous nitroglycerin were necessary. After 42 +/- 6 months 21 patients remained asymptomatic, with 8 still on antianginal therapy. In 27 patients (56%) complications had occurred. These complications were severe limiting angina pectoris in 16, of whom 11 were treated surgically after 3.5 +/- 3 months, and myocardial infarction in 11 patients after 16 +/- 9 months, of whom 4 patients died. Complications occurred in 10 of the 30 patients in group 1 and in 16 of the 18 patients in group 2 (33% vs. 89%, p less than 0.01). This study confirms that the long-term course in patients with unstable angina is often complicated by severe angina pectoris or myocardial infarction. The late response to initial therapy and the need for the combination of more than two antianginal drugs or of i.v. medications identifies a subgroup of patients with a high complication rate.