Comparison of coronary angiographic narrowing in stable angina pectoris, unstable angina pectoris, and in acute myocardial infarction

Objective: To identify clinical and angiographic profiles of patients with unstable angina seen at a tertiary hospital and treated with percutaneous coronary intervention (PCI). Methods:Study of a consecutive series of 1413 patients, selected from a computerized database, who underwent percutaneous revascularization in the three-year period of [2002][2003][2004]. There were no inclusion/exclusion criteria.Results: Systemic arterial hypertension (74%) and hypercholesterolemia (65%) were the classical risk factors for coronary disease most frequently observed. Coronary artery bypass grafting and history of myocardial infarction were found in 24% and 28% of the cases, respectively. The subgroups most commonly treated were the IIB (48%) and IIIB (28%). Clopidogrel was prescribed for 51% of the patients and glycoprotein IIb/IIIa inhibitors, for 7%. Multivessel disease evidenced by coronary angiography was detected in 42% of the cases. Type B2 or C lesions were treated in 64%, 94% of which in native vessels. Restenotic lesions were dilated in 5% of the patients. All interventions were performed using coronary stents, the majority of which (67%) were standard bare-metal stents.Conclusions: 1) Subgroups IIB and IIIB were the most frequently treated (76%); 2) Clopidogrel was the most prescribed antithrombotic agent (51%); 3) Multivessel coronary artery disease was found in 42% of the cases, most of which were complex target lesions located in native vessels; 4) Coronary stent implantation was the chief dilation technique used.Key words: Unstable angina, coronary angioplasty. Unstable angina (UA) is one of the most important medical emergencies because of its high frequency and expressive morbidity and mortality 1,2 . For example, in the United States, approximately 1.3 million patients (p) are hospitalized for this condition each year 3 , a figure that underscores the need for providing the best available treatment for this population.In the second half of the last decade, three randomized clinical trials have proved the superiority of invasive strategy involving coronary angiography and early myocardial revascularization, whenever possible, over the conservative approach [4][5][6] . In this context, percutaneous coronary intervention (PCI) is the revascularization method most widely used. This has been made possible by the development of adjunctive antithrombotic drug therapy (fractionated heparin, glycoprotein IIb/IIIa inhibitors and clopidogrel) and the advent of coronary stents, after which procedural outcomes have become safer and more predictable [4][5][6] . More recently, the introduction of drug-eluting stents has resulted in a significant drop in late clinical events, by considerably reducing angiographic and clinical restenosis rates 7,8 . This investigation sought to identify the main angiographic/ clinical features related to the percutaneous procedure in a consecutive series of patients (p) who underwent PCI in the presence of unstable angina in a very busy tertiary hospital. MethodsA retrospective analysis ...

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“…This is consistent with previous literature reports 18,19 , in which significant obstructive atherosclerosis predominates.…”

Section: Peixoto Et Al Unstable Angina Patients Treated With Percutansupporting

confidence: 94%

Pacientes com angina instável tratados por meio de intervenções coronarianas percutâneas no novo milênio: o que os caracteriza?

Peixoto¹,

Tanajura²,

Sousa³

et al. 2007

Arq. Bras. Cardiol.

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“…Fissure with atherosclerotic plaque rupture and thrombosis, responsible for the great majority 22,23 . The occurrence of a greater number or coronary stenoses has been verified in patients with stable angina than in patients with unstable angina or myocardial infarction, thus demonstrating the human body's natural adaptation mechanism that could be optimized by a full medical treatment including rehabilitation resources, especially physical exercises 24,25 . In addition to the patients' choice not to undergo intervention treatment, with or without their physician's support, since patients frequently refused the intervention treatment proposed, the results of the studies mentioned [19][20][21][22][23][24][25] allowed us to keep these patients with hemodynamically significant chronic coronary stenoses subject to intervention treatment from the anatomic point of view in the rehabilitation program.…”

Section: Discussionmentioning

confidence: 99%

Reabilitação cardiovascular de portadores de cardiopatia isquêmica submetidos a tratamento clínico, angioplastia coronariana transluminal percutânea e revascularização cirúrgica do miocárdio

Carvalho¹,

Curi²,

Andrade³

et al. 2007

Arq. Bras. Cardiol.

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Objective: To evaluate the occurrence of death and myocardial infarction in subgroups of coronary artery disease patients with hemodynamically significant coronary stenoses undergoing treatment in a cardiovascular rehabilitation program and considered severely ill for: a) not having undergone intervention treatment; b) presenting signs of myocardial ischemia; c) presenting multivessel occlusive disease.Methods: Retrospective cohort study of 381 patients presented previous coronary angiography showing hemodynamically significant coronary stenoses, for which, because of the anatomic bias, intervention treatment was indicated. The patients were categorized according to the presence or absence of intervention treatment; presence or absence of ischemia in the exercise test; and number of critical coronary stenoses. Statistical analysis was performed using the Kaplan-Meier and logistic regression methods.Results: Survival probability was not different when patients undergoing medical treatment were compared to those undergoing previous intervention treatment (OR 0.813; 95% CI; 0.366-1.809); with and without evidence of ischemia in the exercise test (OR 0.785; 95% CI; 0.366-1.684); and with one-vessel coronary artery disease and with more-than-one-vessel coronary artery disease (OR 0.824, 95% CI; 0.377-1.798). Conclusion:In this cohort study, no unfavorable outcome was observed in the subgroups comprised of medically treated patients, with evidence of myocardial ischemia and with multivessel coronary artery disease.

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“…Achados até certo ponto surpreendentes têm sido identificados pelos estudos que relacionaram, de modo evolutivo, severidade da obstrução coronária com a correspondente área de infarto, demonstrando que a artéria com maior obstrução não era a responsável pela nutrição da área infartada 29 . Da mesma maneira, trabalhos comparando a DAC entre pacientes com angina estável crônica e IM como 1ª manifestação concluíram que a severidade e a extensão da doença era maior no grupo com angina estável 12 Outros estudos relacionaram o comprometimento arterial coronário entre pacientes com angina estável crônica, angina instável e IM como primeira manifestação, demonstrando que o comprometimento das artérias coronárias era similar entre os pacientes com angina instável e IM e mais severo nos pacientes com angina estável 13 . No grupo de pacientes avaliados neste estudo, a doença aterosclerótica foi mais severa e extensa nos pacientes com IM do que nos pacientes com angina do peito.…”

Section: Discussionunclassified

“…Este achado vem demonstrar que a nossa população não difere de outras estudadas quanto aos malefícios do fumo na aterosclerose coronária e seus eventos clínicos 12,13,[30][31][32][33] . Baseando-se nos resultados e na metodologia utilizada no presente trabalho, concluímos que na população estudada, composta por habitantes do sul do país, os pacientes com IM têm maior número de artérias comprometidas, grau de estenose mais severo e número de oclusões totais do que os portadores de angina do peito sem IM.…”

Section: Discussionunclassified

“…Estudos recentes demonstraram, ainda, que pacientes com IAM e angina instável apresentavam doença coronária menos extensa e menos grave do que pacientes com síndrome isquêmica crônica (angina estável). Esse achado foi atribuído à participação de fenômenos trombóticos e espasmódicos, como fatores precipitantes das síndromes isquêmicas agudas 12,13 . Aliado a este fato, Little e col observaram, através de cineangiocoronariografias seriadas, não ser possível afirmar que o segmento coronário mais acometido por aterosclerose seja o determinante de IM subseqüente 14 .…”

unclassified

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Comparação da aterosclerose coronária em pacientes com infarto do miocárdio e angina do peito

Manfroi

Zago

Leitão

et al. 1998

Arq. Bras. Cardiol.

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Purpose -To compare the severity of the coronary heart disease and the presence of coronary risk factors between angina and myocardial infarction (MI) patients. Methods -We studied 62 patients with MI and 129 with angina through coronary angiography to evaluate occlusion (lesion of 99% or 100%), extent (with a score of 0-5 derived by the number of vessels affected) and severity (3 groups of different stenosis degrees

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Comparison of coronary angiographic narrowing in stable angina pectoris, unstable angina pectoris, and in acute myocardial infarction

Cited by 35 publications

References 29 publications

Pacientes com angina instável tratados por meio de intervenções coronarianas percutâneas no novo milênio: o que os caracteriza?

Pacientes com angina instável tratados por meio de intervenções coronarianas percutâneas no novo milênio: o que os caracteriza?

Reabilitação cardiovascular de portadores de cardiopatia isquêmica submetidos a tratamento clínico, angioplastia coronariana transluminal percutânea e revascularização cirúrgica do miocárdio

Comparação da aterosclerose coronária em pacientes com infarto do miocárdio e angina do peito

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