Coronary angioplasty in patients with unstable angina: Clinical, electrocardiographic and angiographic predictors of in-hospital outcome

Background. In unstable angina early coronary arteriography is frequently performed, often followed by percutaneous revascularization with liberal use of stents. We intended to study the in-hospital outcome of patients receiving this treatment. Methods. From April 1997 to April 1998, patients submitted to coronary arteriography due to unstable angina, and with no previous myocardial revascularization, were included in a multicenter registry. Results. Out of 987 patients enrolled at 14 centers, 876 (89%) had percutaneous or surgical revascularization. Coronary angioplasty was performed in 571 patients (58%); 281 (49%) had Braunwald class IIIB or C angina. Refractory or prolonged chest pain, or both, were present in 133, 217 and 85 patients, respectively, and multivessel disease in 245 patients (43%). Stenting was performed in 486/571 cases (85%), abciximab was administered to 42 patients, and ticlopidine and/or aspirin to all. A procedural success was obtained in 96.9% of cases. In-hospital major adverse cardiac events occurred in 29/571 patients (5.1%). Pain-related ST segment depression (44% of cases) was not predictive of outcome after coronary angioplasty. In multivariate analysis prolonged plus refractory angina (p = 0.02), an ejection fraction <0.4 (p = 0.04), multivessel disease (p = 0.01) and - with the strongest predictive value - ad hoc angioplasty (p = 0.007) and use of > 1 stent (p = 0.0008) were all independent predictors of in-hospital adverse outcome. Conclusions. Coronary angioplasty with a liberal use of stents yields a high rate of procedural success, with few in-hospital major cardiac events also in 'high risk' patients.