Coronary angioplasty for treatment of unstable angina with transient marked ST-segment elevation

The immediate and short-term results of coronary angioplasty were analysed in 16 patients who presented with chest pain at rest associated with transient marked ST-segment elevation (^0-5 mV). The number of in hospital ischaemic attacks was on average 2-8 (range 1-8). All patients had at least one haemodynamically significant coronary artery stenosis for angioplasty. Multivessel coronary artery disease was present in 37% (6 of 16 patients). Before angioplasty the patients were premedicated with a combination ofnitroglycerin, calcium-antagonists and beta-receptor blockers. The initial success rate was 87 % (14 of 16 patients). There were no deaths and no urgent CABG. Two patients sustained a procedure related myocardial infarction; in one patient a cerebrovascular accident occurred. After a mean follow-up of 13 ±8 months (range 3-25) angina had recurred in 19 % (3 of 16 patients). One patient died due to carcinoma of the lung. Repeat angiography was performed 3-2 ± 1-7 months after the procedure. Angiographic restenosis had occurred in 27 % (4 of15patients) at this time. These results suggest that angioplasty in these patients is effective in relieving ischaemic symptoms and in preventing progression to myocardial infarction. Rest angina associated with marked ST-segment elevation suggests impending infarction and tha