Is all unstable angina the same? insights from the Coronary Angioplasty Versus Excisional Atherectomy Trial

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Updated: Jul 22, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

R A Harrington1, R M Califf, D R Holmes

  • 1Duke Clinical Research Institute, Durham, NC, USA.

American Heart Journal
|January 30, 1999
PubMed

Insights

Unstable angina patients face higher percutaneous revascularization complication risks, with specific subgroups like those with electrocardiographic changes experiencing worse outcomes. Clinical presentation is key to identifying high-risk patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Unstable angina is linked to poorer results following percutaneous revascularization.
  • Identifying specific unstable angina presentations associated with adverse outcomes is crucial for risk stratification.

Purpose of the Study:

  • To compare percutaneous revascularization outcomes in patients with and without unstable angina.
  • To analyze outcomes across different unstable angina subgroups within the CAVEAT-I trial.

Main Methods:

  • Comparison of outcomes between patients with (n=690) and without (n=320) unstable angina in the CAVEAT-I trial.
  • Subgroup analysis based on anginal presentation: rest chest pain, postinfarction chest pain, chest pain with ischemic ECG changes, chest pain with recent acceleration, and no chest pain.
  • Construction of regression models to predict in-hospital and 6-month composite endpoints (death, infarction, bypass surgery, revascularization, abrupt closure/restenosis).

Main Results:

  • Chest pain with electrocardiographic changes significantly predicted worse in-hospital composite outcomes (24% vs 17%, P=.0374) and showed greater acute gain, late loss, and restenosis.
  • Rest chest pain was associated with a higher incidence of the composite 6-month outcome (39.9% vs 29%, P=.0472).
  • Atherectomy demonstrated worse overall outcomes compared to angioplasty across all unstable angina categories.

Conclusions:

  • Patients with unstable angina generally experience more percutaneous revascularization complications than those without.
  • The specific clinical presentation of unstable angina influences complication rates, with certain subgroups facing particularly high risks.
  • Clinical presentation can aid in identifying unstable angina patients at elevated risk for adverse events after revascularization.
Abstract

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