Coronary angiographic findings in various types of unstable angina - Study on the pathophysiology of unstable angina.

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Coronary angiographic findings were studied in 129 patients with various types of unstable angina in order to clarify the pathophysiology of unstable angina. The subjects were divided into 3 types : effort angina (E), rest angina (R), and effort and rest angina (E+R), and each of these 3 types was subdivided into group I (new onset), II (recurrent) and III (changing pattern). 1) R had less severe coronary lesions than E or E+R. 2) Severity and distribution of coronary atherosclerotic lesions in unstable angina were similar to those in stable angina. 3) Incidence of coronary spasm is higher in unstable R and E+R than in stable R and E+R, respectively. 4) Unstable R and E+R with frequent attacks were associated with a higher frequency of coronary spasm and severe proximal coronary stenosis than those without frequent attacks, respectively. 5) Among unstable E+R-III (changing pattern), the patients who developed E+R from E showed significantly higher incidence of multiple vessel disease than those who developed E+R from R and significantly lower incidence of spontaneous spasm than those with E+R, who remained with the same pattern but in whom the frequency and/or the intensity of the attack increased, without any significant difference in the severity of coronary stenosis from other 2 subgroups. It is concluded that coronary spasm as well as severe coronary atherosclerotic lesions may be responsible for the unstable state of angina. Especially in R and E+R, coronary spasm is the most important factor responsible for the unstabilization of angina.
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