THE COURSE OF UNSTABLE ANGINA AND ITS THE RAPEUTIC IMPLICATIONS - BASED UPON 74 CASES

The role of thrombosis in the pathogenesis of unstable angina has been demonstrated experimentally. This retrospective study was designed to identify the potential usefulness of fibrinolytic treatment in this s ituation. The following parameters were evaluated in 74 patients (62 m en, 12 women; mean age: 60 +/- 10.2) with primary unstable angina: the course of unstable angina (Braunwald classification), risk factors, e lectrocardiographic changes, echocardiographic segmental kinetics, cor onary arteriography findings, treatment used and outcome with a minimu m follow-up of 3 months (mean : 6.3 months). Thirty nine per cent of c lass I patients and 18 % of classes Il and III were stabilised by medi cal treatment only. This accounted for 18 patients in our series (24 % ). The other patients (76 %) required one or more reperfusion techniqu es (thrombolysis : 5 patients; angioplasty : 42; bypass : 19). Serious complications were seen in 3 patients : myocardial infarction : 2 pos toperative (including one fatal) and 1 occuring 24 hours after angiopl asty followed by cardiogenic shock and death. Five patients required t hrombolytic treatment leading to clinical stabilisation enabling an ad ditional procedure (angioplasty or bypass). No complications of thromb olytic treatment were seen. Thus thrombolytic treatment appears to be useful for the stabilisation of unstable angina and enables subsequent radical treatment under better conditions.