ACUTE PULMONARY-EDEMA IN PATIENTS WITH UNSTABLE ANGINA - CLINICAL PROFILE AND NATURAL-HISTORY

Background: Pulmonary edema is an important manifestation of ischemic cardiac dysfunction, both in the presence and absence of myocardial infarction. However, the clinical characteristics and natural history of pulmonary edema with unstable angina have not been fully evaluated. Methods: One hundred twenty patients admitted to our hospital within 6 hours from the onset of last chest pain were studied. Clinical features were reviewed from hospital charts and coronary angiography was performed in acute phase (33 patients) and in the late hospital phase (62 patients). The mean follow-up period was 26 months. Results: Pulmonary edema was present in 24 patients and was absent in 96 patients. The duration of chest pain was longer (P<0.01) and incidence of multivessel disease was higher (P<0.01) in patients with pulmonary edema than those without it. The total mortality rate in patients with pulmonary edema was higher that those without it (33% vs 3%; <0.001). These data indicate that a large mass of ischemic myocardium could cause transient increase of left ventricular diastolic pressure to pulmonary edema level without infarction ever occurring. Conclusions: Because of the high incidence of multivessel disease and the poor prognosis in patients with pulmonary edema in unstable angina, early and aggressive diagnostic efforts should be undertaken to exclude viable segments of myocardium in patients with unstable angina complicated by pulmonary edema.