IMPORTANCE OF DELAYING BALLOON ANGIOPLASTY IN PATIENTS WITH UNSTABLE ANGINA-PECTORIS

Angioplasty in patients with unstable coronary artery disease is assoc iated with higher complication rates compared with patients with stabl e disease. In this report we describe our results from a group of pati ents with unstable disease (unstable angina pectoris and postmyocardia l infarction) where a strategy of delaying angioplasty for >5 days aft er admission was undertaken. Included are 2069 consecutive patients: 1 197 treated for stable angina pectoris and 872 treated during admissio n for unstable angina or myocardial infarction. There was no differenc e between the two groups in angioplasty success (92.1% stable, 92.3% u nstable), failure to dilate without complication (6.4% stable, 6.1% un stable), or in the rate of major complications: death (0.5% stable, 1. 1% unstable), Q-wave myocardial infarction (0.9% stable, 1.1% unstable ), and emergency coronary artery bypass (0.6% stable, 0.3% unstable). The duration of hospitalization following angioplasty was longer in th e unstable group (5.6 +/- 8.1 days vs. 4.2 +/- 4.1 days; p < 0.001) be cause of longer duration of heparin infusion. There was no difference between groups in minor complications such as groin hematoma and pseud oaneurysm, renal failure, or infections. It was concluded that delayin g angioplasty in unstable patients for > 5 days after admission is a s afe and effective therapeutic strategy for this group of patients. The need for prolonged heparin infusion after angioplasty is increased in unstable patients and thus the duration of hospitalization after the procedure is longer.