RT Journal Article
SR Electronic
T1 Is preinfarction angina related to the presence or absence of coronary plaque rupture?
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 64
OP 68
DO 10.1136/heart.83.1.64
VO 83
IS 1
A1 S Kojima
A1 H Nonogi
A1 Y Miyao
A1 S Miyazaki
A1 Y Goto
A1 A Itoh
A1 S Daikoku
A1 T Matsumoto
A1 I Morii
A1 C Yutani
YR 2000
UL http://heart.bmj.com/content/83/1/64.abstract
AB OBJECTIVE To analyse the prodrome of acute myocardial infarction in relation to the plaque morphology underlying the infarct.DESIGN A retrospective investigation of the relation between rupture and erosion of coronary atheromatous plaques and the clinical characteristics of acute myocardial infarction. The coronary arteries of 100 patients who died from acute myocardial infarction were cut transversely at 3 mm intervals. Segments with a stenosis were examined microscopically at 5 μm intervals. The clinical features of the infarction were obtained from the medical records.RESULTS A deep intimal rupture was encountered in 81 plaques, whereas 19 had superficial erosions only. There were no differences in the location of infarction, the incidence of hypertension, diabetes mellitus, or hyperlipidaemia, diameter stenosis of the infarcted related artery, Killip class, Forrester's haemodynamic subset, or peak creatine kinase between plaque rupture and plaque erosion groups. The presence of plaque rupture was associated with significantly greater incidences of leucocytosis, current smoking, and sudden or unstable onset of acute coronary syndrome. In patients with unstable preinfarction angina, new onset rest angina rather than worsening angina tended to develop more often in the plaque rupture group than in the plaque erosion group (p = 0.08).CONCLUSIONS Plaque rupture causes the sudden onset of acute myocardial infarction or unstable preinfarction angina, which may be aggravated by smoking and inflammation.