Coronary artery diseaseSeverity of Coronary Arterial Stenoses Responsible for Acute Coronary Syndromes
Section snippets
Methods
A total of 317 patients belonging to the 3 groups defined according to clinical presentation were included in this prospective study of (1) 102 consecutive patients with STEMI referred for primary PCI, (2) 135 patients with non-STEMI or unstable angina pectoris (UAP) referred for semiurgent PCI, and (3) 80 patients with stable angina pectoris (SAP) admitted for elective coronary angioplasty.
The STEMI group consisted of patients strictly meeting the 4 criteria of (1) onset of symptoms ≥30
Results
Main clinical characteristics of the 3 groups of patients are listed in Table 1. Patients presenting with STEMI were significantly younger and had less arterial hypertension compared with patients with non-STEMI/UAP or SAP. Although left ventricular ejection fraction of patients with STEMI was on average in the normal range, it was still significantly lower than in the 2 other groups of patients.
Main angiographic data for the 3 groups are listed in Table 2. Incidences of left anterior
Discussion
In this study, angiographic assessment of lesion severity was objectively quantified in patients with acute myocardial infarction after aspiration of the occlusive thrombus. Data suggested that STEMI predominantly occurred at sites with angiographic diameter stenosis >50%. Only approximately 10% of patients with STEMI had a culprit lesion with diameter stenosis <50% after aspiration of thrombus material. Similarly, in patients with non-STEMI/UAP, in whom aspiration was not performed, diameter
References (30)
- et al.
Intravenous streptokinase in evolving acute myocardial infarction
Am J Cardiol
(1984) - et al.
Comparison of patients with <60% to >60% diameter narrowing of the myocardial infarct-related artery after thrombolysis
Am J Cardiol
(1994) - et al.
Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging
J Am Coll Cardiol
(1998) - et al.
Differential effects of drug eluting stents on local endothelium dependent coronary vasomotion
J Am Coll Cardiol
(2008) - et al.
Angiographic progression of coronary artery disease and the development of myocardial infarction
J Am Coll Cardiol
(1988) - et al.
Coronary stenoses before and after myocardial infarction
Am J Cardiol
(1989) - et al.
Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography
Am J Cardiol
(1992) - et al.
Clinical and angiographic predictors of new total coronary occlusion in coronary artery disease: analysis of 313 nonoperated patients
Am J Cardiol
(1984) - et al.
Intravascular ultrasound profile analysis of ruptured coronary plaques
Am J Cardiol
(2006) - et al.
In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis
J Am Coll Cardiol
(2005)
Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS)CASS Participating Investigators and Staff
J Am Coll Cardiol
Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study
J Am Coll Cardiol
Angioscopic follow-up study of coronary ruptured plaques in nonculprit lesions
J Am Coll Cardiol
What does the clinical cardiologist need from noninvasive cardiac imaging: is it time to adjust practices to meet evolving demands?
J Nucl Cardiol
Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function
Am Heart J
Cited by (65)
Dynamic natural morphologies and component changes in nonculprit subclinical atherosclerosis in patients with acute coronary syndrome at 1-year follow-up and clinical significance at 3-year follow-up
2022, AtherosclerosisCitation Excerpt :Beta-blocker use was also associated with LR in our analysis, but due to a lack of relevant supporting research, our interpretation of this result remains cautious; we look forward to the confirmation of this finding in future studies with larger samples. Previous studies have alerted us to the need to pay attention to nonculprit lesions in patients with ACS, since these lesions promote an incidence of MACEs similar to that of culprit lesions that were not treated by PCI in the previous 3 years [23,47–49]. Currently, most culprit lesions in ACS patients are treated with PCI, so MACEs caused by nonculprit lesions have received increased attention.
Assessment of Total-Body Atherosclerosis by PET/Computed Tomography
2021, PET ClinicsFrom Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review
2019, Journal of the American College of CardiologyFrom Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events: JACC State-of-the-Art Review
2019, Journal of the American College of Cardiology