[Percutaneous coronary angioplasty in unstable angina and acute infarction].

Unstable angina represents an indication for percutaneous transluminal coronary angioplasty (PTCA) provided it is based on a significant fixed lesion. A primary success rate of about 90% can be expected, but in 5% to 10% the intervention will cause a myocardial infarction. Mortality is higher than in patients with stable angina and does not differ from that of bypass surgery; however, it is still below 1%. At 1 year, 50% to 90% of the patients treated with initial success are asymptomatic if redilatations for recurrences (occurring in about one third) are included. - Acute myocardial infarction was introduced as an indication for PTCA in about 1980. PTCA was first used for failures, then for incomplete successes of intracoronary streptokinase therapy, and finally in patients without pretreatment. Currently, PTCA is being evaluated in multicenter studies as an adjunct to early intravenous fibrinolysis with clot specific agents (e.g., tissue-type plasminogen activator). PTCA achieves adequate initial reperfusion in about 80% irrespective of concomitant fibrinolytic therapy. It is complicated by occlusion of an already partially recanalized vessel in 4%. Late reocclusions occur in 15%, half of them accompanied by reinfarction. Intrahospital mortality is about 5% and increases by 1% up to 1 year. PTCA has its place in the treatment of unstable angina and acute infarction. In the latter it may be advantageous to precede it with early intravenous fibrinolysis.