Elsevier

American Heart Journal

Volume 136, Issue 3, September 1998, Pages 382-388
American Heart Journal

Angiographic characteristics of infarct-related and non-infarct-related stenoses in patients in whom stable angina progressed to acute myocardial infarction,☆☆,

https://doi.org/10.1016/S0002-8703(98)70210-8Get rights and content

Abstract

Background In patients with coronary artery disease, angiographic and postmortem studies have shown that coronary stenoses in infarct-related arteries often have complex morphology. It is not known whether in patients with multivessel disease stenosis morphology in non-infarct-related arteries is different from those of the infarct-related arteries. Methods and Results In 24 consecutive patients we examined the angiographic characteristics of both the infarct-related stenoses and non-infarct-related stenoses before and after spontaneous acute myocardial infarction, by visual inspection and computerized edge detection of coronary angiograms. Before myocardial infarction, the severity of the infarct-related stenoses was <50% in 14 patients and ≥50% in 10 patients (p = not significant) and of non-infarct-related stenoses was <50% in 16 and ≥50% in 13. A significantly greater proportion of infarct-related stenoses with severity ≥50% progressed to non-Q-wave than to Q-wave myocardial infarction (71% vs 50%, p < 0.05). Before myocardial infarction, the percentage of concentric, eccentric, and irregular infarct-related stenoses was 8%, 13%, and 50%, respectively, whereas in the non-infarct-related stenoses it was 62%, 17%, and 21%, respectively (p < 0.01). A similar proportion of irregular morphology progressed to Q-wave or non-Q-wave myocardial infarction. Conclusions In patients with stable angina who had acute myocardial infarction develop, the infarct-related and non-infarct-related stenoses on average are similar in severity but different in morphology. Nonsevere stenoses more frequently progress to Q-wave than to non-Q-wave myocardial infarction. (Am Heart J 1998;136:382-8.)

Section snippets

Patients

We examined the preinfarction and postinfarction angiograms of 24 consecutive patients (19 men and 5 women, aged 36 to 74 years, Table I) admitted with acute myocardial infarction who had previously undergone coronary angiography for a history of stable angina. The previous arteriograms had been obtained a mean of 26 ± 4 months before the onset of myocardial infarction. Coronary arteriography was repeated 2.2 ± 0.5 weeks after acute myocardial infarction as part of the patient’s clinical

Results

Before myocardial infarction, 13 (54%) patients had a family history of coronary artery disease, 16 (67%) were smokers, 10 (42%) had hypercholesterolemia, and 6 (25%) had hypertension (Table I).

Discussion

Our study shows that the development of myocardial infarction cannot be predicted from the severity of preexisting stenosis, but it is related to the morphology and indicates that an irregular eccentric morphology is significantly more common in infarct-related than in non-infarct-related stenoses. Nonsevere stenoses more frequently progress to Q-wave than to non-Q-wave myocardial infarction.

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    From the Cardiovascular Unit, Royal Postgraduate Medical School, Hammersmith Hospital, the Department of Cardiology, St. Bartholomew’s Hospital, and Istituto di Cardiologie Faculta di Medicina e Chirurgia “Agosfino Gemelli,”Universita Cattolica del Sacro Cuore.

    ☆☆

    Reprint requests: Graham J. Davies, Division of Clinical Cardiology, Hammersmith Hospital, Ducane Rd., London W12 ONN, United Kingdom.

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