Management of Crescendo Angina

The purpose of this study was to focus on the clinical and angiographical characteristics of patients with crescendo angina (i.e. worsening angina, including rest pain occurring against the background of previously established angina) compared with those with angina of recent onset and to discuss the results of medical and surgical treatment in this particular subset of patients. One hundred and thirteen patients with a pattern of crescendo angina, admitted to our clinic between January 1976 and July 1983, showed a greater incidence of prior transmural myocardial infarction (P < 0·01), arterial hypertension (P < 0·01), multivessel disease (P < 0·01) and a lower value of left ventricular ejection fraction (P < 0·05) than 183 patients with angina of new onset observed during the same period of time. Although medical treatment was able to stabilize symptoms in 69 patients with crescendo angina, 44 underwent urgent coronary bypass surgery, while another 25 patients had to be operated on during the first six-month follow-up. At the end of this period the cumulative probability of failure for medical therapy was 62%. Survival curves up to five years showed that medically treated patients with crescendo angina had a worse long-term prognosis than patients with unstable angina of new onset (P<001). On the contrary, no difference in survival was found between the surgically treated patients in the two groups.