Actuality in the treatment of unstable angina pectoris
L J Szatmáry1, J Marco, J Fajadet
1Department of Cardiovascular Surgery, Semmelweis University Medical School, Budapest, Hungary.
Insights
Coronary angioplasty effectively relieved ischemic symptoms in 236 patients with multivessel coronary heart disease and unstable angina. The procedure demonstrated an 87% initial success rate, offering a viable treatment option for refractory cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Multivessel coronary heart disease (MVD) with unstable angina (UA) poses significant risks, including myocardial infarction.
- Medical management with calcium antagonists, beta-blockers, and nitroglycerin may be insufficient for refractory UA.
- Urgent revascularization is crucial for symptom relief and preventing adverse cardiac events.
Purpose of the Study:
- To evaluate the efficacy and safety of emergency coronary angioplasty in patients with MVD and refractory UA.
- To assess the procedural success, early complications, and long-term outcomes of angioplasty in this high-risk population.
Main Methods:
- A cohort of 236 patients with MVD and UA, unresponsive to medical therapy, underwent coronary angioplasty.
- Unstable angina was defined by rest pain >20 min with reversible ST-T changes.
- Follow-up data was collected for 191 successfully treated patients over an average of 14 months.
Main Results:
- Initial angioplasty success rate was 87% (205/236).
- Procedural complications included urgent bypass surgery (2.1%), myocardial infarction (3.4%), and death (2.9%).
- At 14-month follow-up, late mortality was 4.2%, late nonfatal infarction 2.6%, with 30% experiencing restenosis or new stenosis.
Conclusions:
- Emergency coronary angioplasty is a feasible and effective intervention for multivessel coronary heart disease patients with unstable angina refractory to medical treatment.
- The procedure offers acceptable risks and good short-term outcomes, restoring coronary blood flow.
- Despite restenosis rates, angioplasty provides significant initial relief and can be followed by repeat procedures or bypass surgery if needed.
Abstract:
In an attempt to relieve ischaemic symptoms and to prevent progression to myocardial infarction, coronary angioplasty was attempted in 236 multivessel coronary heart disease patients with unstable angina, refractory to medical treatment including oral Ca2+ antagonists, beta blockers and nitroglycerin drugs. Unstable angina was defined as ischaemic chest pain at rest lasting for at least 20 min, accompanied by reversible ST-T changes. The initial angioplasty success rate was 87% (205/236 cases). Vessel occlusion necessitating urgent bypass surgery occurred in five patients (2.1%). There was evidence of myocardial infarction in eight patients (3.4%). There were seven deaths (2.9%) related to the procedure. 191 of the 205 successfully dilated patients were followed up for 14 months on the average. Late mortality occurred in 4.2% (8/191), late nonfatal infarction in 2.6%, 127 patients remained asymptomatic and 11 were considered to be disabling angina (New York Heart Association classification III or IV). Recurrent angina rate with progression in ischaemic disease (restenosis and native vessel stenosis) occurred in 30%. For this reason, repeated angioplasty and elective bypass surgery were performed in 48 and 14 cases, respectively. These results support the growing evidence that angioplasty as an emergency procedure in multivessel disease patients with unstable angina pectoris refractory to intensive medical treatment can restore coronary blood flow with an acceptable risk and a good initial and short-term success rate.
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