Kma. Hussain et al., UNSTABLE ANGINA OF CRESCENDO PATTERN VS NEW-ONSET - A CLINICAL, CORONARY ARTERIOGRAPHIC AND HEMODYNAMIC-STUDY, Angiology, 46(6), 1995, pp. 497-502
Citations number
NO
Categorie Soggetti
Medicine, General & Internal","Cardiac & Cardiovascular System","Peripheal Vascular Diseas
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.