CLINICAL AND CORONARY ARTERIOGRAPHIC FEATURES AND OUTCOME OF RECENT-ONSET UNSTABLE ANGINA

Fifty consecutive patients (43 male and seven female; mean age 51.8 ye ars) with recent onset angina (24.6% of all admissions for unstable an gina during a 1-year period) underwent coronary arteriography. Most pa tients (96.8%) presented with severe angina (Canadian Cardiovascular S ociety Class III-IV) with admission ECG changes of myocardial ischemia in 46%. Echocardiography (within 2 days of admission) showed normal l eft ventricular function (LVEF > 50%) in 80% and mild or moderate impa irment (LVEF 35-49%) in 12% of patients. Segmental wall motion abnorma lities were noted in a small number (12.9%). Coronary angiography reve aled significant (greater-than-or-equal-to 70% diameter stenosis) dise ase in one vessel in 14 (28%), in two vessels in seven (14%), three ve ssels in 22 (44%) and no disease in seven (14%) patients. Significant left main stenosis (greater-than-or-equal-to 50% diameter stenosis) wa s present in two (5%) patients. Left anterior descending artery was mo re commonly involved (66%) as compared to the other arteries. A signif icantly higher incidence of multivessel disease was observed in patien ts with diabetes mellitus (P < 0.003) and in smokers (P < 0.04). Multi ple coronary artery involvement was more common in patients with three or more risk factors for coronary artery disease (P < 0.005). In-hosp ital non fatal myocardial infarction occurred in three (6%) patients. During follow-up (average 13 +/- 1.28 months) 30 (60%) patients underw ent coronary artery bypass surgery, 13 (26%) required coronary angiopl asty while seven (14%) were managed by drugs alone with no further mor tality and significant symptomatic relief. Patients with recent onset angina, in our setting, frequently have severe multiple vessel coronar y artery disease. Early evaluation of such patients is important for a ppropriate management to reduce morbidity and mortality.