EARLY PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN UNSTABLE ANGINA

The risks of complications of percutaneous transluminal coronary angio plasty (PTCA) are increased in unstable angina. Medical treatment for a few days before PTCA is widely adopted to reduce the risk of thrombo sis or occlusive dissection during and after the procedure. Over the l ast few years, the authors have adopted a strategy of early coronary a ngiography completed by immediate angioplasty when possible, without w aiting for the eventual benefit of aspirin or heparin therapy. Their e xperience from 1988 to 1995 of 853 patients treated by PTCA (151/853 o r 17.7 %, with implantation of a stent) for unstable angina, was revie wed. Group I comprised 402 patients treated on the day of or the day a fter admission. Group II comprised 451 patients treated 2 days or more after admission. Patients in Group I were younger (62 +/- 11 vs 64 +/ - 12, p <0.001), and had single vessel disease more often (61 vs 52 %, p <0.005). The success rate of PTCA was similar in the 2 groups (85.3 vs 88.2 %, NS), as was the rate of complications (death, infarction o r coronary bypass surgery, 9.9 vs 7.3 %, NS). The length of hospital s tay was significantly shorter in Group I (6.1 +/- 5.6 vs 8.7 +/- 6.9 d ays, p <0.0001). With the limitations inherent to all retrospective st udies, these data suggest that an early interventional approach in uns table angina has a similar success rate with no more complications tha n angioplasty. This approach is associated with a deferred significant decrease the duration of hospital stay.