Treatment of refractory unstable angina in geographically isolated areas without cardiac surgery. Invasive versus conservative strategy (TRUCS study).

AIMS: We compared invasive (on-site coronary angioplasty or emergency air-ambulance transfer for bypass grafting surgery) vs conservative (persistent medical treatment) strategies in the management of refractory unstable angina in geographically isolated hospitals without cardiac surgical facilities. METHODS AND RESULTS: One hundred and forty eight randomized patients with refractory unstable angina were compared on an intention-to-treat basis. Outcomes (invasive vs conservative): (a) in hospital: stabilization (96% vs 43%, P=0.0001), non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (1.3% vs 8.3%, P=0.046), combined outcome (3.9% vs 12.5%, P=0.053) and hospitalization (11.4+/-6.3 vs 12.4+/-8.0 days, P=ns). (b) 30-days follow-up: non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (2.6% vs 11.1%, P=0.030) and combined outcome (5.3% vs 15.3%, P=0.031). (c) 12 month follow-up: non-fatal myocardial infarction (3. 9% vs 4.2%, P=ns), death (3.9% vs 12.5%, P=0.053), combined outcome (7.9% vs 16.7%, P=ns), re-admissions for unstable angina: (17.1% vs 23.6%, P=ns), late coronary angioplasty: (15.8% vs 11.1%, P=ns) and (d) late coronary bypass grafting: (7.9% vs 12.5%, P=ns). CONCLUSION: Invasive treatment of patients with refractory angina in remote areas without surgical back-up results in significant in-hospital stabilization and a reduction in major events in-hospital and at 30 days. Coronary angioplasty in stand-alone units and air-transfer of these patients seems safe.

Usefulness of Renal Arteriography Following Coronary Angiography.

PURPOSE: To determine the usefulness of renal angiography in patients that underwent coronary angiography because of clinically suspected coronary artery disease. METHODS: Selective arteriography of the renal arteries was performed in 205 patients (mean age 60 +/- 8 years; 80% males) at the time after coronary angiography with the use of right coronary Judkins catheter. RESULTS: Two-hundred renal angiographies were judged technically adequate. Average additional fluoroscopy time was 3 +/- 2 min and 30 +/- 8 ml of additional contrast medium was used. Coronary artery disease (³ 50% narrowing) was found in 158 (79%). Renal arterial disease was found in 17 (8.5%) patients. Reduction in lumen diameter was < 50% in 11 patients (5.5%) including 3 patients with bilateral stenosis, and ³ 50% in 6 patients (3%). The only clinical variable associated with renal artery stenosis was peripheral vascular disease. CONCLUSION: There is no justification for doing routine renal angiography for patients undergoing coronary arteriography because the prevalence of severe renal artery stenosis is low.

[Single coronary artery]. / Artère coronaire unique.

A single coronary artery is a rare abnormality of the coronary circulation (0.09% in the authors' experience), a fortuitous finding on coronary angiography. The authors report three new cases of this abnormality, including one with a ventricular septal defect and another with ischaemic heart disease. Exercise stress testing was positive in two patients.