Historical comparative evolution of two clinical forms of unstable angina

pp 241-246

Abstract

In order to assess the present evolution of two clinical forms of unstable angina and to compare it with the natural history of the syndrome, we performed a prospective study consisting of the follow-up of 136 consecutive patients admitted to the coronary care unit with the diagnosis of new onset angina (n = 57) or progressive angina (n = 79). The observation period included both the in-hospital and the post-hospital phases and lasted four months. The incidence of myocardial infarction and death were 3.6 % and 0 % for new onset angina, and 9.3 % and 5.3 % for progressive angina respectively (p: NS). The need for invasive treatment because of refractory angina was higher for progressive angina (29.3 % vs 14.5 '10; p < 0.05). When the figures for myocardial infarction and death were compared with those observed by our group twenty years ago, we found a significant reduction in the event rates for new onset angina (infarction, from 34'10 to 3.6 %; death, from 8.5 % to 0 '10) while no changes were seen in progressive angina. It is concluded that the remarkable reduction of major events observed in the global evolution of unstable angina in the last years is mostly explained by the changes occurred in new onset angina. In our experience, a conservative approach for the management of this clinical form of unstable angina has yielded promising results.