International Journal of Cardiology, 39 (1993) 173-180 0 1993 Elsevier Scientific Publishers Ireland Ltd. All tights reserved. 0167.5273/93/%06X1 173 CARD10 01693 Clinical and coronary arteriographic features and outcome of recent onset unstable angina A. Kanojia, R. Kasliwal, A. Seth, S. Bhandari, T.S. Kler and M.L. Bhatia Escorts Heart Institute and Research Centre, Okhla Road, New Delhi-l IO 025. India (Received 7 September 1992; revision accepted 7 January 1993) Fifty consecutive patients (43 male and seven female; mean age 51.8 years) with recent onset angina (24.6% of all admissions for unstable angina during a l-year period) underwent coronary arteriography. Most patients (96.8%) presented with severe angina (Canadian Cardiovascular Society Class III-IV) with admission ECG changes of myocardial ischemia in 46O/o. Echocardiography (within 2 days of admission) showed normal left ventricular function (LVEF > 50%) in 80% and mild or moderate impairment (LVEF 35-49%) in 12% of patients. Segmental wall motion abnormalities were noted in a small number (12.9%). Coronary angiography revealed significant (~70% diameter stenosis) disease in one vessel in 14 (28%), in two vessels in seven (14%), three vessels in 22 (44%) and no disease in seven (14%) patients. Significant left main stenosis (L 50% diameter stenosis) was present in two (5%) patients. Left anterior descending artery was more commonly involved (66%) as compared to the other arteries. A significantly higher inci- dence of multivessel disease was observed in patients with diabetes mellitus (P < 0.003) and in smokers (P < 0.04). Multiple coronary artery involvement was more common in patients with three or more risk factors for coronary artery disease (P < 0.005). In-hospital non fatal myocardial infarction occurred in three (6%) patients. During follow-up (average 13 f 1.28 months) 30 (60%) patients underwent coronary artery bypass surgery, 13 (26”/0)required coronary angioplasty while seven (14O/o) were managed by drugs alone with no further mortality and significant symptomatic relief. Patients with recent onset angina, in our setting, frequently have severe multiple vessel coronary artery disease. Early evaluation of such patients is important for appropriate management to reduce morbidity and mortality. Key words: Unstable angina; Recent onset angina; Coronary arteriography zyxwvutsrqponmlkjihgfedcbaZYXWVUT Introduction Unstable angina is a form of acute ischaemic heart disease intermediate between stable angina of effort and acute myocardial infarction. It carries an increased risk of myocardial infarction and death. Evaluation of unstable angina has been Correspondence to: Professor M.L. Bhatia, Medical Director and Chief of Cardiology, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi-l 10 025, India. complicated by conflicting reports on short and long-term prognosis of the affected patient [l-9]. Chahine [lo] suggested that subgroups within the unstable population may account for the reported variable prognosis. Recent onset angina is one subgroup of unstable angina. It is defined as the development of angina pectoris within the preceding 60 days in patients with no previous symptoms [ 111. Various studies have included this subgroup, along with others, for assessment of the clinical characteristics, arteriographic anatomy