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[Coronary angiographic characteristics of patients with unstable angina]
Insights
Unstable angina patients show varied coronary lesion characteristics. Rest angina patients often have severe disease, while early post-infarction angina frequently involves total occlusions and coronary thrombi, suggesting intensive treatment is needed.
Area of Science:
- Cardiology
- Internal Medicine
- Vascular Biology
Background:
- Unstable angina (UA) encompasses a spectrum of acute coronary syndromes.
- Understanding the specific coronary lesion characteristics in different UA subtypes is crucial for risk stratification and treatment.
- Previous studies have highlighted variations, but a comprehensive analysis across diverse UA presentations is warranted.
Purpose of the Study:
- To investigate and compare the distinct coronary lesion characteristics and angiographic findings in patients presenting with various forms of unstable angina.
- To identify specific lesion patterns associated with different angina subtypes, including new onset effort angina, rest angina, early post-infarction angina, and Prinzmetal variant angina.
- To correlate angiographic findings with the presence of coronary thrombi and guide therapeutic strategies.
Main Methods:
- A retrospective analysis of coronary angiograms and clinical data from 388 patients diagnosed with unstable angina.
- Classification of patients into distinct angina groups: new onset effort angina, aggravated effort angina, rest angina, early post-infarction angina, and Prinzmetal variant angina.
- Detailed assessment of coronary lesion severity (single, triple vessel disease, left main coronary artery involvement), lesion complexity (Type C), degree of occlusion, and presence of coronary thrombi.
Main Results:
- Single vessel disease was more prevalent in new onset effort angina (69.64%).
- Rest angina patients exhibited a higher frequency of triple vessel disease (72.34%) and left main coronary artery lesions (27.66%), complex (Type C) lesions (60.64%), and subtotal/total occlusions (36.07%).
- Early post-infarction angina was associated with a high rate of subtotal or total occlusions (53.12%) and coronary thrombi (20.00%), which were also more frequent in patients with chest pain at rest (16.39%). Prinzmetal variant angina patients mostly had mild coronary lesions.
Conclusions:
- Coronary lesion characteristics significantly differ across unstable angina subtypes.
- Patients with angina at rest and early post-infarction angina present with more severe coronary artery disease and a higher incidence of thrombus formation, necessitating more aggressive management.
- Intensified treatment, including strengthened anticoagulation, is recommended for patients with angina at rest and early post-infarction angina to improve outcomes.
Abstract:
In order to study the characteristics of coronary lesions of patients with unstable angina, coronary angiograms and clinical manifestations were analysed on 388 patients. The results were as follows: single vessele disease was more common in new onset effort angina (69.64%) than in other groups (P < 0.05). Triple vessele disease and left main coronary artery lesion appeared more frequently in patients with rest angina than in other groups (72.34% and 27.66% respectively, P < 0.05), so did complex lesions and type C lesions (36.07% and 60.64% respectively, P < 0.05). More than half of the culprit lesions in early postinfarction angina was subtotal or total occlusions (53.12%), being more frequently found in this than in other groups (P < 0.05). Most of the patients with Prinzmetal variant angina had mild coronary lesions only. Coronary thrombi were found in 10.45% of the 388 patients; they were was more frequent in patients with early postinfarction angina (20.00%) than in the groups of new onset effort angina, aggravated effort angina and Prinzmetal variant angina (4.26%, 7.53% and 0% respectively, P < 0.05). Coronary thrombi were also more frequent in the patients with chest pain at rest (16.39%) than in the groups of new onset effort angina and Prinzmetal variant angina (P < 0.05). It is suggested that patients with angina at rest should be treated more intensively. Strengthened anticoagulation treatment should be given to patients with early postinfarction angina and angina at rest.