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Actuality in the treatment of unstable angina pectoris.

In an attempt to relieve ischaemic symptoms and to prevent progression to myocardial infarction, coronary angioplasty was attempted in 236 multivessel coronary heart disease patients with unstable angina, refractory to medical treatment including oral Ca2+ antagonists, beta blockers and nitroglycerin drugs. Unstable angina was defined as ischaemic chest pain at rest lasting for at least 20 min, accompanied by reversible ST-T changes. The initial angioplasty success rate was 87% (205/236 cases). Vessel occlusion necessitating urgent bypass surgery occurred in five patients (2.1%). There was evidence of myocardial infarction in eight patients (3.4%). There were seven deaths (2.9%) related to the procedure. 191 of the 205 successfully dilated patients were followed up for 14 months on the average. Late mortality occurred in 4.2% (8/191), late nonfatal infarction in 2.6%, 127 patients remained asymptomatic and 11 were considered to be disabling angina (New York Heart Association classification III or IV). Recurrent angina rate with progression in ischaemic disease (restenosis and native vessel stenosis) occurred in 30%. For this reason, repeated angioplasty and elective bypass surgery were performed in 48 and 14 cases, respectively. These results support the growing evidence that angioplasty as an emergency procedure in multivessel disease patients with unstable angina pectoris refractory to intensive medical treatment can restore coronary blood flow with an acceptable risk and a good initial and short-term success rate.