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[Refractory unstable angina. Emergency treatment by coronary artery angioplasty under aortic counterpulsion]
F Chague1, J P Colle, N Delarche
1Hôpital Cardiologique, INSERM U8, Université de Bordeaux II, Pessac.
Insights
Emergency transluminal coronary angioplasty with intra-aortic balloon pump support effectively treated refractory unstable angina in 13 patients, achieving an 80% immediate success rate and stabilizing most patients for discharge.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Context:
- Refractory unstable angina poses a significant clinical challenge.
- Emergency interventions are crucial for patients with acute coronary syndromes.
- Intra-aortic balloon counterpulsation provides hemodynamic support during critical cardiac events.
Purpose:
- To evaluate the efficacy and safety of emergency transluminal coronary angioplasty (PTCA) in patients with refractory unstable angina.
- To assess the role of intra-aortic balloon pump (IABP) counterpulsation in stabilizing patients prior to or during PTCA.
- To determine the immediate and short-term outcomes of this combined approach.
Summary:
- Fifteen emergency PTCA procedures were performed in 13 patients with refractory unstable angina, supported by IABP.
- Patients presented with threatening infarction or extended infarction, often with electrocardiographic changes and hemodynamic compromise.
- Coronarography identified significant stenosis (92%) in culprit arteries, with PTCA chosen due to surgical unsuitability.
- Immediate arteriographic and clinical success was achieved in 80% of cases (12/15), with 2 cases of transmural infarction and 1 failure.
- Ten patients were stabilized and discharged, while 2 underwent bypass surgery and 1 died of complications.
Impact:
- Emergency PTCA with IABP support demonstrates a high success rate in managing high-risk unstable angina patients.
- This approach offers a viable alternative for patients unsuitable for immediate surgical revascularization.
- Successful intervention can stabilize hemodynamics, reduce infarct size, and improve patient outcomes in acute coronary syndromes.
Abstract:
We report our experience of 15 transluminal coronary angioplasties performed in an emergency in 13 patients (mean age 67 +/- 8 years) with refractory unstable angina. The procedures were conducted under diastolic counterpulsation effected by means of an intra-aortic balloon. The angina was of the threatening infarction type on 11 occasions and of the threatening extended infarction on 4 occasions. Electrocardiographic abnormalities were recorded in the anterior (11 cases) or in the inferior (4 cases) territory. Three patients had a very alarming haemodynamic status, with acute pulmonary oedema in two and cardiogenic shock in one. After intra-aortic counterpulsation was installed and the clinical signs were stabilized, coronaro-ventriculography was performed, leading to a decision of immediate angioplasty since age, underlying diseases, myocardial function and diffused lesions made most of the patients unsuitable for surgery. In multiple vessel patients electric and angiographic data were used to locate the tight stenosis (92% in all cases) responsible for the acute coronary ischaemia. The stenosis was found to affect the anterior interventricular artery in 9 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a saphenous shunt on the anterior interventricular artery in 2 cases. Immediate arteriographic and clinical success was obtained in 12 out of 15 cases (80%); there were 3 failures with 2 transmural infarctions. Later on, 2 patients underwent aorto-coronary bypass and 1 died of myocardial failure and pulmonary superinfection 3 weeks after the procedure. Ten of our 13 patients were stabilized and were discharged under medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)