[Pre-infarction syndrome involving the anterior interventricular artery. Therapeutic and diagnostic considerations]

Based on the study of 25 cases, the authors define menace syndrome in the anterior descending artery (ADA) according to three criteria: angina of recent onset and rapid development, a major disorder of repolarisation in the anterior part of the heart, and a tight proximal stenosis of the ADA. Of seven patients who could not undergo surgery, three sustained anterior infarctions, and three died after 30 days. 18 patients underwent surgery to revascularise the myocardium by anastomosis of the internal mammary artery to the ADA; 13 of these were carried out as urgent procedures (an average of 26 hours after coronary arteriography). The functional results were excellent, and all of the internal mammary anastomoses studied at 6 months (9 cases) were patent. This study has shown that menace syndrome of the ADA is a surgical emergency, and that a procedure to anastomose the coronary arteries should be carried out immediately after coronary anteriography.