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Clinical and coronary arteriographic features and outcome of recent onset unstable angina
A Kanojia1, R Kasliwal, A Seth
1Escorts Heart Institute and Research Centre, New Delhi, India.
Insights
Recent onset angina often indicates severe coronary artery disease, frequently affecting multiple vessels. Early diagnosis and intervention are crucial for managing this condition and improving patient outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Recent onset angina is a common presentation for unstable angina.
- Patients often present with severe symptoms and ECG changes indicative of myocardial ischemia.
Purpose of the Study:
- To investigate the coronary artery disease profile in patients presenting with recent onset angina.
- To assess the prevalence of multivessel disease and identify associated risk factors.
Main Methods:
- Coronary arteriography was performed on 50 consecutive patients with recent onset angina.
- Echocardiography assessed left ventricular function and segmental wall motion abnormalities.
- Patient data including risk factors, comorbidities, and in-hospital events were analyzed.
Main Results:
- Significant coronary artery disease (>=70% stenosis) was found in 72% of patients, with 44% having three-vessel disease.
- Left anterior descending artery involvement was most common (66%).
- Multivessel disease was significantly more prevalent in patients with diabetes mellitus (P < 0.003) and smokers (P < 0.04).
- Patients with three or more risk factors showed a higher incidence of multiple coronary artery involvement (P < 0.005).
- In-hospital non-fatal myocardial infarction occurred in 6% of patients.
Conclusions:
- Recent onset angina frequently signifies severe, multivessel coronary artery disease.
- Diabetes mellitus and smoking are significant predictors of multivessel disease in this patient group.
- Effective management strategies, including revascularization and medical therapy, lead to symptomatic relief and no further mortality during follow-up.
Abstract:
Fifty consecutive patients (43 male and seven female; mean age 51.8 years) with recent onset angina (24.6% of all admissions for unstable angina during a 1-year period) underwent coronary arteriography. Most patients (96.8%) presented with severe angina (Canadian Cardiovascular Society Class III-IV) with admission ECG changes of myocardial ischemia in 46%. Echocardiography (within 2 days of admission) showed normal left ventricular function (LVEF > 50%) in 80% and mild or moderate impairment (LVEF 35-49%) in 12% of patients. Segmental wall motion abnormalities were noted in a small number (12.9%). Coronary angiography revealed significant (> or = 70% diameter stenosis) disease in one vessel in 14 (28%), in two vessels in seven (14%), three vessels in 22 (44%) and no disease in seven (14%) patients. Significant left main stenosis (> or = 50% diameter stenosis) was present in two (5%) patients. Left anterior descending artery was more commonly involved (66%) as compared to the other arteries. A significantly higher incidence of multivessel disease was observed in patients with diabetes mellitus (P < 0.003) and in smokers (P < 0.04). Multiple coronary artery involvement was more common in patients with three or more risk factors for coronary artery disease (P < 0.005). In-hospital non fatal myocardial infarction occurred in three (6%) patients. During follow-up (average 13 +/- 1.28 months) 30 (60%) patients underwent coronary artery bypass surgery, 13 (26%) required coronary angioplasty while seven (14%) were managed by drugs alone with no further mortality and significant symptomatic relief. Patients with recent onset angina, in our setting, frequently have severe multiple vessel coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)