Unstable rest angina. Coronary anatomy and evaluation of medical therapy.

The results of beta blockers and nitrates therapy were evaluated in 100 consecutive patients with unstable angina (72 with previous stable angina, 28 with recent onset angina), 89 patients had also a history of effort angina and 11 patients had only rest angina. In 92 of 100 patients selective coronary arteriography revealed fixed obstructive coronary artery disease in 86 patients and coronary artery spasm with normal coronary arteries in 6 patients. In 58 of 100 patients beta blockers and nitrates effectively controlled angina, and immediate coronary artery bypass graft surgery was avoided. In 42 patients early and in 22 patients late surgery were needed. 29 patients remained stable on long term beta blockers and nitrates therapy. Thus, despite the possibility of increased coronary vasomotor tone as the mechanism of rest angina, beta blockers and nitrates remain effective immediate medical therapy.