원저 : 불안정형 협심증의 임상 및 간동맥 조영상의 특성과 그에 따른 치료법

The pathophysiology of unstable angina is known to be in continuum with acute myocardial infarction, and its treatment requires timely intervention using haparin iv, thrombolysis, and/or percutaneous transluminal coronary angioplasty, or bypass graft along with conventional measures. We analyzed the clinical and angiographic findings of 72patients with unstable angina and the treatments performed on them and compared the results with those of 50patients with stable angina to know differences existing between the 2groups. The results were as follows; 1) There were no statistical differences in clinical characteristics, including coronary risk factors between patients with unstable angina vs patients with stable angina (p>0.05). 2) Multivessel and left main diseases were more prevalent in patients with unstable angina (61% and 13%, respectively) compared to patients with stable angina (34% and 4%, respectively)(p<0.05). 3) Type B2 (42% and C (34%) lesions were more common in patients with unstable angina, while type A (23%) and B1 (32%) lesions were more common in patients with stable angina (p<0.05). 4) Most unstable patients (94%) were initially stabilized by medical treatment only, but the probability requiring surgical treatment (CABG) was significantly higher in patients with unstabe angina than in patients with stable angina (25% vs 6%)(p<0.05). Unstable angina has more complex coronary lesions and is precipitated frequently by platelet aggregation or thrombus associated with rupture of the atheromatous plaque. Most unstable angina could be stabilized with medical treatment only. However if chest pain does not remit by 48hours after medical therapy, more aggessive modalities such as thrombolysis, PTCA or CABG seem to be justified.