[Course of unstable angina and therapeutic implications. Apropos of 74 cases]

The role of thrombosis in the pathogenesis of unstable angina has been demonstrated experimentally. This retrospective study was designed to identify the potential usefulness of fibrinolytic treatment in this situation. The following parameters were evaluated in 74 patients (62 men, 12 women; mean age: 60 +/- 10.2) with primary unstable angina: the course of unstable angina (Braunwald classification), risk factors, electrocardiographic changes, echocardiographic segmental kinetics, coronary arteriography findings, treatment used and outcome with a minimum follow-up of 3 months (mean: 6.3 months). Thirty nine per cent of class I patients and 18% of classes II and III were stabilised by medical treatment only. This accounted for 18 patients in our series (24%). The other patients (76%) required one or more reperfusion techniques (thrombolysis: 5 patients; angioplasty: 42; bypass: 19). Serious complications were seen in 3 patients: myocardial infarction: 2 postoperative (including one fatal) and 1 occurring 24 hours after angioplasty followed by cardiogenic shock and death. Five patients required thrombolytic treatment leading to clinical stabilisation enabling an additional procedure (angioplasty or bypass). No complications of thrombolytic treatment were seen. Thus thrombolytic treatment appears to be useful for the stabilisation of unstable angina and enables subsequent radical treatment under better conditions.