UNSTABLE ANGINA OF CRESCENDO PATTERN VS NEW-ONSET - A CLINICAL, CORONARY ARTERIOGRAPHIC AND HEMODYNAMIC-STUDY

Unstable angina includes a variety of clinical presentations with a di fferent level of risk for an unfavorable outcome. In this study the au thors investigated the prognostic significance of crescendo angina and new-onset angina to discuss management strategies, paying attention t o the relevance of baseline clinical characteristics, coronary artery lesions, and left ventricular function, as well as their alterations d uring atrial pacing. Accordingly coronary arteriographic anatomy and c hanges in left ventricular volumes and ejection fraction before and du ring atrial pacing were studied by means of digital subtraction ventri culography in 18 patients with crescendo angina and in 18 patients wit h new-onset angina. Triple-vessel disease was more frequently observed in crescendo angina (56%; P < 0.05) as compared with the patients wit h new-onset angina (11%). Complex coronary morphology was statisticall y more likely to be found in crescendo angina. The angiographic eviden ce of intracoronary thrombi was found in 33% (P < 0.05) patients with crescendo angina and in 4% patients with new-onset angina. Compared wi th the patients with new-onset angina, patients with crescendo angina had higher end-diastolic and end-systolic volumes and lower ejection f raction at rest. At peak pacing, ejection fraction was significantly ( P < 0.05) lower in crescendo angina (0.48 +/- 0.06) than in new-onset angina (0.66 +/- 0.04). In crescendo angina, during pacing, the magnit ude of velocity of circumferential fiber shortening was significantly decreased as compared with new-onset angina. Thus, our findings docume nt more extensive coronary atherosclerosis and more severe left ventri cular dysfunction in patients with crescendo angina than in patients w ith new-onset angina, which may explain the poorer outcome in the form er subgroup of patients.