[Acute coronary angiography in therapy-refractory angina pectoris].
Emergency coronary angiography was performed in 188 patients with treatment-resistant unstable angina. Criteria analysed were: duration of angina less than 72 h; angina despite heparin and nitroglycerin infusion; no significant S-T segment elevation in the ECG; creatine-kinase rise up to 150 U/l. Coronary heart disease (CHD) was found in 130 patients (group A). In 47 of them a recent coronary occlusion was demonstrated angiographically (main stem: 1; anterior interventricular branch: 8; circumflex branch: 27; right coronary artery: 11 patients). An at least 90% occlusion of one coronary artery was found in 58 patients. A 75% stenosis of several vessels was found in 25 patients making it impossible to identify the vessel that had caused the angina. A bypass operation was performed in 62 patients within two weeks. During the acute coronary angiography, intracoronary streptokinase infusion was performed in 11 (success rate 55%), percutaneous transluminal coronary angioplasty in 26 (success rate 88%). In 58 patients (group B) CHD was excluded. The final diagnosis in these was: mitral valve prolapse (31); pericarditis (6), dilated cardiomyopathy (3); coronary anomaly (3); muscle bridge in the anterior interventricular branch (2): normal (13).


CONCLUSIONS
It is not possible to decide with certainty, in the absence of typical infarction signs in the ECG and clinically, whether treatment-resistant angina is due to CHD or other causes. Acute coronary angiography is indicated in such cases, because even without S-T segment elevation an acute coronary occlusion is present in 25%, and in 50% of cases an acute therapeutic intervention is indicated.
Tebbe
U
U
Sauer
G
G
Kreuzer
H
H
Vogt
A
A
Bethge
K P
KP
Wiegand
V
V
Neuhaus
K L
KL
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use
D006493:Heparin; D005996:Nitroglycerin
Akut-Koronarangiographie bei therapierefraktärer Angina pectoris.