Concepts for the initial management of patients with unstable angina pectoris - From the viewpoint of coronary arteriography, coronary circulation and cardiac performance including various interventional studies.

The problems involved in the treatment, the criterion for selective initial treatment, and the relationship between the treatment and the prognosis were studied in 48 patients with unstable angina pectoris, based on coronary arteriographic findings, left ventricular performance, coronary circulation and myocardial energetics with various interventional observations. Among these patients 43.7% initially responded to medication and 56.3% did not. In newly developed angina at rest, the effectiveness of an isolated sustained administration of isosorbide dinitrate (ISDN) or Ca2+ antagonist (nifedipine) was 100%, while in the changing pattern type of effort angina, the effectiveness of nifedipine was 71.4%, being higher than that of other drugs. As for coronary circulation, nifedipine, having different effects from ISDN, acted directly on resistance vessels and increased the endocardium/epicardium blood flow ratio by its powerful preload-unloading effect. Percutaneous transluminal coronary angioplasty (PTCA) was performed on 5 patients with unstable angina pectoris (USP). A completely asymptomatic condition, significant dilatation and improvement of coronary circulation were obtained after PTCA. The prognosis of UAP was not good with a mortality rate of 21%. Therefore, initial intensive medical therapies and the earliest stabilization of the patients' conditions are also important. The mechanism of the resistance to medical treatment is an important problem to be solved in the near future. In addition to the validity of the definitions of this disease, the appropriate long-term management must also be considered.