Related Experiment Videos
[Angina at rest. Clinical, electrocardiographic and angiographic observations in 107 patients]
Insights
Patients with ST segment elevation during angina have less severe coronary artery disease than those with ST segment depression. Surgical intervention appears beneficial for patients with multivessel disease unresponsive to medical therapy.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- 107 patients with rest angina and ST segment changes were analyzed.
- Two groups were identified: ST segment elevation (Group I, 46 patients) and ST segment depression (Group II, 61 patients).
Purpose:
- To differentiate coronary artery disease patterns and treatment outcomes based on ST segment changes during angina.
- To evaluate the efficacy of medical and surgical treatments in patients with angina at rest.
Summary:
- Group I patients more frequently had non-significant or one-vessel coronary artery disease.
- Group II patients more frequently presented with multivessel disease and left main coronary artery involvement.
- Left ventricular function depression was similar in both groups.
- Medical treatment (calcium antagonists, nitrates) resulted in one death and eleven non-fatal myocardial infarctions.
- Coronary bypass grafting in 50 patients led to four perioperative deaths and six non-fatal myocardial infarctions.
- Surgical outcomes were satisfactory for patients with multivessel disease or left main involvement, particularly those unresponsive to medical treatment.
Impact:
- Highlights distinct coronary artery disease profiles associated with different ST segment responses during angina.
- Suggests that coronary bypass grafting offers satisfactory results for high-risk patients with severe coronary artery disease unresponsive to medical management.
Abstract:
107 patients suffering from angina at rest associated with ST segment changes underwent coronary arteriography. 46 patients showed ST segment elevation during ischemic attacks (group I) while 61 patients exhibited ST segment depression during chest pain (group II). Non-significant coronary artery disease was more frequent in group I patients (group I 15%, group II 5%) as well as one vessel disease (group I 33%, group II 15%) while multivessel disease and left main involvement were more frequent in group II patients (group I 28%, group II 60%). Depression of left ventricular function was found in similar percentage of cases in both groups. During hospitalization all patients were treated with calcium antagonists (Nifedipine 10/20 mg every six hours) and/or nitrates (2% nitroglycerin ointment 2 inches every six/four hours) with one death (occurring after coronary arteriography) and eleven non-fatal myocardial infarctions. 50 patients underwent coronary bypass grafting with four perioperative deaths and six nonfatal myocardial infarctions. Most of the surgically treated patients were poorly responsive to medical treatment and had multivessel disease or left main involvement. Since these features are known to be related to a poor prognosis with medical treatment, surgical results in such patients seem satisfactory.