title: Coronary angioplasty for unstable angina: immediate and late results in 200 consecutive patients with identification of risk factors for unfavorable early and late outcome.
abstract: Two hundred patients (mean age 56 years, range 36 to 74) with unstable angina (chest pain at rest, associated with ST-T changes) underwent coronary angioplasty. In 65 patients with multivessel disease, only the "culprit" lesion was dilated. The initial success rate was 89.5% (179 of 200 patients). At least one major procedure-related complication occurred in 21 patients (10.5%): (death in 1, myocardial infarction in 16 and urgent surgery in 18). All patients were followed up for 2 years. Five patients died late; 8 had a late nonfatal myocardial infarction and 52 had recurrence of angina pectoris. The restenosis rate was 32% (51 of 158) in the patients with initial successful angioplasty who had repeat angiography. At the 2 year follow-up, after attempted coronary angioplasty in all 200 patients, the total incidence rate of death was 3% (one procedure related; five late deaths), of nonfatal myocardial infarction 12% (16 procedure related and 8 late after angioplasty), and 13% (26 patients) were still symptomatic although they had improved in functional class. Multivariate analysis showed that variables indicating an increased risk 1) for major procedure-related complications were: ST segment elevation, persistent negative T wave and stenosis greater than or equal to 65% (odds ratio 3.7, 3.7 and 3.3, respectively); 2) for angiographic restenosis were: presence of collateral vessels, ST segment depression, multivessel disease, left anterior descending coronary artery stenosis and history of recent onset of symptoms (odds ratio: 2.2, 2.0, 1.9, 1.9 and 0.54, respectively); and 3) for late coronary events (recurrence of angina, late myocardial infarction or late death) were: multivessel disease, total occluded vessel and ST segment elevation (odds ratio 3.7, 2.8 and 0.44, respectively). Thus, coronary angioplasty for unstable angina can be performed with a high initial success rate, but at an increased risk of major complications. The prognosis is favorable after initial successful coronary angioplasty.
authors.affiliation: Thoraxcenter, University Hospital, Erasmus University, Rotterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.forename: P W
authors.initials: PW
authors.lastname: Serruys
authors.forename: K
authors.initials: K
authors.lastname: Beatt
authors.forename: R
authors.initials: R
authors.lastname: van Domburg
authors.forename: M
authors.initials: M
authors.lastname: van den Brand
authors.forename: J J
authors.initials: JJ
authors.lastname: Tijssen
authors.forename: A J
authors.initials: AJ
authors.lastname: Azar
authors.forename: P G
authors.initials: PG
authors.lastname: Hugenholtz
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000009:adverse effects; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors