OUTCOME OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN SUBSETS OF UNSTABLE ANGINA-PECTORIS - A REPORT OF THE 1985-1986 NATIONAL-HEART,-LUNG,-AND-BLOOD-INSTITUTE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY REGISTRY

Objectives. The purpose of this study was to characterize the outcome of coronary angioplasty according to the various presentations of unst able angina pectoris. Background. Although unstable angina is a mosaic of clinical manifestations, a comprehensive analysis of short- and lo ng term outcome of coronary angioplasty in subsets of unstable angina is not available. Methods. Data from 15 clinical centers far the 857 p atients with unstable angina in the 1985-1986 National Heart, Lung, an d Blood Institute percutaneous transluminal coronary angioplasty regis try were analyzed. Five year follow-up was available in >96.5%. Patien ts were first classified as those with (679 [79%]) or without (178 [21 %]) rest angina. Patients were also allocated to five mutually exclusi ve categories of decreasing unstable angina severity: postinfarction a ngina, acute coronary insufficiency, plain rest angina, accelerating a ngina and new onset angina. Results. The group with rest angina had mo re older patients (p < 0.01) and women (p < 0.001), and a greater prop ortion had a previous myocardial infarction (p < 0.001) and a left ven tricular ejection fraction less than or equal to 50% (p < 0.01) than d id the group without rest angina. Angiographic characteristics were ne arly the same, whereas procedural characteristics and outcome were the same for both categories. At 5-year follow-up, there was a higher cru de mortality rate in patients with than without rest angina (p < 0.05) . Resolution into five subsets yielded additional information. Women w ere more represented only in the acute coronary insufficiency and plai n rest angina subsets (p < 0.001). Patients with angina after myocardi al infarction had the second shortest history of angina (p < 0.001), t he highest percent of smokers (p < 0.01) and, with those with acute co ronary insufficiency, the highest incidence of congestive heart failur e (p < 0.05) and an ejection fraction less than or equal to 50% (p < 0 .001). They had the highest percent of totally occluded arteries, coro nary thrombus and collateral blood flow received but also the lowest r ate of severe stenoses (p < 0.001 for all). Patients with new onset an gina had the highest prevalence of single-vessel disease (p < 0.05), c ritical and complex stenoses (p < 0.001) and no coronary angioplasty-r elated deaths. The crude 5-year mortality rate was higher for both pos tinfarction and acute insufficiency groups (p < 0.05) than for the oth er subsets. After adjustments for risk factors, no significant differe nces in adverse event rates remained among the different unstable angi na subgroups. Conclusions. Analysis of the diverse clinical presentati ons of unstable angina supports underlying pathogenetic differences. C oronary angioplasty is safe and effective in ah subsets of unstable an gina. Long term survival is good in general but is related to the base line status of left ventricular function.