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Directional coronary atherectomy in unstable angina
A E Abdelmeguid1, S G Ellis, S K Sapp
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
Journal of the American College of Cardiology
|July 1, 1994
Summary
Directional coronary atherectomy outcomes differ significantly in unstable angina patients compared to stable angina. Unstable angina patients, particularly those with rest or postinfarction symptoms, face higher complication risks during percutaneous interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Unstable angina presents higher risks for angioplasty compared to stable angina, likely due to thrombus-associated plaque.
- Directional coronary atherectomy (DCA) is a percutaneous intervention used to treat coronary stenosis.
Purpose of the Study:
- To compare the outcomes of directional atherectomy in patients with unstable angina versus stable angina.
- To assess if excising complex, ulcerated plaque in unstable angina improves procedural risk.
Main Methods:
- A study of 287 patients undergoing DCA for single-vessel stenosis.
- Patients were categorized into three groups: stable angina (Group I, n=77), unstable angina without rest/postinfarction symptoms (Group II, n=110), and unstable angina with rest/postinfarction symptoms (Group III, n=100).
Main Results:
- Major ischemic complications were significantly higher in Group III (7%) compared to Group I (1.3%) and Group II (0.9%) (p=0.036).
- This difference was primarily driven by a higher incidence of emergency bypass surgery in Group III (5%, p=0.05).
- At a mean 22-month follow-up, Group III showed a higher rate of hospital admission for angina (p=0.05) and trends toward more bypass surgery and myocardial infarction, with no difference in repeat interventions.
Conclusions:
- The definition of unstable angina is crucial for predicting immediate directional atherectomy outcomes.
- In the absence of rest or postinfarction angina, immediate results are comparable to stable angina.
- Atherectomy's impact on immediate and short-term outcomes in unstable angina is less significant than the underlying pathophysiology, which increases percutaneous intervention complications.