UNSTABLE ANGINA Coronary angioplasty for early postinfarction unstable angina

Coronary angioplasty was performed in 53 patients in whom unstable angina had reoccurred after 48 hr and within 30 days after sustained myocardial infarction. Single-vessel disease was present in 64% of the patients and multivessel disease in 36%. The preceding myocardial infarction had been small to moderate in size in the majority of the patients. The left ventricular ejection fraction was more than 50% in 80% of the patients. Forty-five patients were refractory to pharmacologic treatment; eight were initially stabilized but once again became symptomatic with light exertion. Angioplasty was performed in 35 patients 2 to 14 days and in 18 patients 15 to 30 days after infarction (average 12 + 7 days after infarction). The initial success rate was 89% (47/53). The success rate of the patients treated at 2 to 14 days was lower (29/35, 83%) than that of patients treated at 14 to 30 days (18/18, 100%) but did not reach statistical significance (p < .06). There were no deaths related to the procedure. In four of the six failures, emergency bypass surgery was performed and two patients sustained a myocardial infarction. Furthermore, a myocardial infarction complicated the angioplasty procedure in two other patients; thus the overall procedure-related myocardial infarction rate was 8% (4/53). At 6 months follow-up, 26% (14/53) of all the patients who underwent angioplasty had recurrence of angina, which was successfully treated with repeat angioplasty, bypass surgery, or medical therapy. There were no late deaths. Late myocardial infarction occurred in two patients. Thus the total myocardial infarction rate after angioplasty at 6 months was 1 1% (6/53 patients). In 42 of the 47 (89%) patients with successful angioplasty, angiography was repeated a mean 3.3 ± 2.5 months after angioplasty. The angiographic restenosis rate was 33%. We conclude that in selected patients, coronary angioplasty for unstable angina occurring 48 hr to 30 days after a myocardial infarction is an effective treatment with an acceptable risk, a high initial success rate, and a sustained beneficial effect. Circulation 74, No. 6, 1365-1370, 1986 THE PRESENCE of ischemic yet viable myocardium in a patient with angina early after an infarction places that patient at increased risk of reinfarction,'which carries a poor shortand long-term prognosis.2 4 6 Although bypass surgery in patients with postinfarction angina can be performed with good results, the operative mortality and morbidity rates are less favorable than those for stable angina.71Recently, coronary angioplasty has been shown to be highly effective in the treatment of both stable12 and unstable angina." even in patients who are refractory to optimal pharmacologic treatment. 16 Coronary angioplasty as an alternative to surgery might be an attractive option in the From the Thoraxcenter, University Hospital, Erasmus University, Rotterdam, The Netherlands. Address for correspondence: Pim J. de Feyter, M.D., Catheterization Laboratory, Thoraxcenter, Bd 414, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Received March 14, 1986; revision accepted Aug. 7, 1986. Vol. 74, No. 6, December 1986 management of patients with early postinfarction unstable angina, since it can avoid the attendant risks of major anesthesia and bypass surgery. Our policy over the last few years has been to offer coronary angioplasty to selected patients with unstable angina who, early after acute myocardial infarction, are either refractory to pharmacologic therapy or who experience angina induced by mild exertion despite initial response to maximal pharmacologic therapy. In this study we report our experience with coronary angioplasty in the treatment of patients with unstable angina occurring after 48 hr and within 30 days after myocardial infarction. Patients and methods From January 1983 through September 1985, 2731 patients were admitted to our coronary care unit at the Thoraxcenter. Of these, 101 patients had postinfarction unstable angina and fulfilled the following criteria: (1) chest pain at rest, lasting for at 1365 by gest on N ovem er 7, 2017 http://ciajournals.org/ D ow nladed from