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Patients with unstable angina pectoris have an increased risk of sudden cardiac death, especially when compared with patients with stable angina. The risk of ischemic complications in such patients must be balanced with their benefit from revascularization procedures, such as coronary angioplasty. For patients in whom an immediate, well tolerated clinical response is seen to angioplasty and who have low to moderate left ventricular (LV) dysfunction, improved long-term survival rates can be expected compared with medical therapy alone. The most important prognostic factor appears to be the extent of LV dysfunction, but patients who develop evidence of myocardial ischemia in the early postprocedure period may also be at increased risk of early and late cardiac events. The treatment of angina pectoris in the setting of LV dysfunction has not been studied in a prospective randomized fashion, but it is logical to assume that patients with more extensive underlying disease should be treated by more aggressive medical therapy as well as revascularization procedures. Patients with LV dysfunction and angina pectoris should be evaluated to determine if revascularization will reduce their risk of subsequent myocardial ischemia. There is considerable debate regarding the role of anticoagulation in patients with LV dysfunction and angina pectoris who undergo coronary revascularization. In patients who have LV dysfunction at the time of angioplasty, the possibility of recurrent ischemia in the early postprocedure period and an increased risk of ventricular arrhythmias should be weighed against the risk of thromboembolic events.(ABSTRACT TRUNCATED AT 250 WORDS)Product Details
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