Unstable angina: lesion shape on angiography did not clearly predict outcome.

Clinical bottom line (level 4)

  1. The shape of lesions or the presence of a thrombus on angiplasty, did not clearly predict outcome in patients with unstable angina.
Bar et al: Journal of the American College of Cardiology 1994; 24 (6): 1453-1459
Expires June 2003

The study

Inception cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: three university hospitals, Holland, France and Belgium

105 patients (aged mean 59 years, 75% male) unstable angina, defined as:
  • angina at rest or on minimal exercise, angina of recent onset (less than 4 weeks), last episode of chest within 12 hours of admission
  • ECG changes suggestive of ischaemia (ST elevation or T wave inversion)


Excluded if
  • aged <30 or >70
  • previous MI or cardiac surgery or angioplasty
  • non-ischaemic ST segment changes (eg. LVH)
  • contraindications for thrombolysis
  • unable to determine type of thrombus lesion on angiogram


    • Patients were taken from a randomised controlled trial, where half were randomised to receive alteplase (tPA). All patients had iv heparin, aspirin and antianginal medication as determined by the study protocol.

    100% followed for until discharge
    Outcomes studied:
  • cardiac event death MI, recurence of angina, need for emergency revascularisation

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cardiac event until discharge 79/105 75.2%
    (67.0% to 83.5%)

    prognostic factor for
    cardiac event     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    concentric lesion on angioplasty vs eccentric lesion until discharge 0.86
    (0.70 to 1.07)     		-9
    (-4 to 17)
    thrombus until discharge 0.92
    (0.71 to 1.19)     		-17
    (-5 to 7)

    Comments

    1. In analysis of the subgroups according to lesion morphology , the outcomes remained similar despite if thrombolytics had been given.

    Citation

    1. Bar FW, Raynaud P, Renkin JP, et al: Coronary angiographic findings do not predict clinical outcome in patients with unstable angina. Journal of the American College of Cardiology 1994; 24 (6): 1453-1459
    Search Terms: unstable and angin* in Cogchrane
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient angina
    Intervention or Exposure concentric or eccentric lesion or presence of thrombus
    Outcome cardiac event