ACUTE AND LONG-TERM OUTCOME OF DIRECTIONAL CORONARY ATHERECTOMY FOR STABLE AND UNSTABLE ANGINA

The clinical efficacy and safety of directional coronary atherectomy f or the treatment of stable and unstable angina were assessed in 82 pat ients with stable and 68 patients with unstable angina. Therefore, cli nical and angiographic follow-up was obtained in a prospectively colle cted consecutive series of 150 atherectomy procedures. Restenosis was assessed clinically and by quantitative angiography. The overall clini cal success rate of atherectomy for patients with unstable and stable angina was 88% and 91%, respectively. No significant differences were found for in-hospital event rates between the unstable and stable angi na groups: death (1.5% vs 0%), myocardial infarction (10% vs 6%), and emergency bypass operation (3% vs 2%). These clinical events were rela ted to the occurrence of abrupt occlusions (8.8% in patients with stab le and 6.1% in those with unstable angina; p = NS). Clinical follow-up was achieved in 100% of the patients with stable and unstable angina at a mean interval of 923 and 903 days, respectively. Two-year surviva l rates were 96% and 97% in the populations with unstable and stable a ngina, respectively. There were no significant differences with respec t to bypass surgery and angioplasty, but event-free survival at 2 year s was significantly lower in the unstable (54%) than the stable (69%) angina group. Quantitative coronary angiography did not detect any dif ference in luminal renarrowing during the 6-month angiographic follow- up period. Although directional coronary atherectomy can be performed effectively in patients with unstable and stable angina, the longterm clinical outcome was less favorable in the unstable angina group. The overall higher incidence of adverse events in patients with unstable a ngina occurred despite the excision of unstable plaque material, anal may therefore reflect the inherent instability of the syndrome rather than the inability of atherectomy to establish a persistent success.