Coronary angiographic morphology in myocardial infarction

A link between the pathogenesis of unstable angina and myocardial infarction

John A. Ambrose, Stephen Winters, Rohit R. Arora, Jacob I. Haft, Jonathan Goldstein, K. Peter Rentrop, Richard Gorlin, Valentin Fuster

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Abstract

It has previously been shown that analysis of coronary morphology can separate unstable from stable angina. An eccentric stenosis with a narrow neck or irregular borders, or both, is very common in patients who present with acute unstable angina, whereas it is rare in patients with stable angina. To extend these observations to myocardial infarction, the coronary morphology of 41 patients with acute or recent infarction and nontotally occluded infarct vessels was studied. For all patients, 27 (66%) of 41 infarct vessels contained this eccentric narrowing, whereas only 2 (11%) of 18 noninfarct vessels with narrowing of 50 to less than 100% had this lesion (p < 0.001). In addition, a separate group of patients with acute myocardial infarction who underwent intracoronary streptokinase infusion were also analyzed in similar fashion. Fourteen (61%) of 23 infarct vessels contained this lesion after streptokinase infusion compared with 1 (9%) of 11 noninfarct vessels with narrowing of 50 to less than 100% (p < 0.01). Therefore, an eccentric coronary stenosis with a narrow neck or irregular borders, or both, is the most common morphologic feature on angiography in both acute and recent infarction as well as unstable angina. This lesion probably represents either a disrupted atherosclerotic plaque or a partially occlusive or lysed thrombus, or both. The predominance of this morphology in both unstable angina and acute infarction suggests a possible link between these two conditions. Unstable angina and myocardial infarction may form a continuous spectrum with the clinical outcome dependent on the subsequent change in coronary supply relative to myocardial demand.

Original languageEnglish (US)
Pages (from-to)1233-1238
Number of pages6
JournalJournal of the American College of Cardiology
Volume6
Issue number6
DOIs
StatePublished - Jan 1 1985
Externally publishedYes

Fingerprint

Unstable Angina
Myocardial Infarction
Infarction
Streptokinase
Stable Angina
Neck
Coronary Stenosis
Atherosclerotic Plaques
Angiography
Pathologic Constriction
Thrombosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ambrose, John A. ; Winters, Stephen ; Arora, Rohit R. ; Haft, Jacob I. ; Goldstein, Jonathan ; Rentrop, K. Peter ; Gorlin, Richard ; Fuster, Valentin. / Coronary angiographic morphology in myocardial infarction : A link between the pathogenesis of unstable angina and myocardial infarction. In: Journal of the American College of Cardiology. 1985 ; Vol. 6, No. 6. pp. 1233-1238.
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abstract = "It has previously been shown that analysis of coronary morphology can separate unstable from stable angina. An eccentric stenosis with a narrow neck or irregular borders, or both, is very common in patients who present with acute unstable angina, whereas it is rare in patients with stable angina. To extend these observations to myocardial infarction, the coronary morphology of 41 patients with acute or recent infarction and nontotally occluded infarct vessels was studied. For all patients, 27 (66{\%}) of 41 infarct vessels contained this eccentric narrowing, whereas only 2 (11{\%}) of 18 noninfarct vessels with narrowing of 50 to less than 100{\%} had this lesion (p < 0.001). In addition, a separate group of patients with acute myocardial infarction who underwent intracoronary streptokinase infusion were also analyzed in similar fashion. Fourteen (61{\%}) of 23 infarct vessels contained this lesion after streptokinase infusion compared with 1 (9{\%}) of 11 noninfarct vessels with narrowing of 50 to less than 100{\%} (p < 0.01). Therefore, an eccentric coronary stenosis with a narrow neck or irregular borders, or both, is the most common morphologic feature on angiography in both acute and recent infarction as well as unstable angina. This lesion probably represents either a disrupted atherosclerotic plaque or a partially occlusive or lysed thrombus, or both. The predominance of this morphology in both unstable angina and acute infarction suggests a possible link between these two conditions. Unstable angina and myocardial infarction may form a continuous spectrum with the clinical outcome dependent on the subsequent change in coronary supply relative to myocardial demand.",
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Coronary angiographic morphology in myocardial infarction : A link between the pathogenesis of unstable angina and myocardial infarction. / Ambrose, John A.; Winters, Stephen; Arora, Rohit R.; Haft, Jacob I.; Goldstein, Jonathan; Rentrop, K. Peter; Gorlin, Richard; Fuster, Valentin.

In: Journal of the American College of Cardiology, Vol. 6, No. 6, 01.01.1985, p. 1233-1238.

Research output: Contribution to journalArticle

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T1 - Coronary angiographic morphology in myocardial infarction

T2 - A link between the pathogenesis of unstable angina and myocardial infarction

AU - Ambrose, John A.

AU - Winters, Stephen

AU - Arora, Rohit R.

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N2 - It has previously been shown that analysis of coronary morphology can separate unstable from stable angina. An eccentric stenosis with a narrow neck or irregular borders, or both, is very common in patients who present with acute unstable angina, whereas it is rare in patients with stable angina. To extend these observations to myocardial infarction, the coronary morphology of 41 patients with acute or recent infarction and nontotally occluded infarct vessels was studied. For all patients, 27 (66%) of 41 infarct vessels contained this eccentric narrowing, whereas only 2 (11%) of 18 noninfarct vessels with narrowing of 50 to less than 100% had this lesion (p < 0.001). In addition, a separate group of patients with acute myocardial infarction who underwent intracoronary streptokinase infusion were also analyzed in similar fashion. Fourteen (61%) of 23 infarct vessels contained this lesion after streptokinase infusion compared with 1 (9%) of 11 noninfarct vessels with narrowing of 50 to less than 100% (p < 0.01). Therefore, an eccentric coronary stenosis with a narrow neck or irregular borders, or both, is the most common morphologic feature on angiography in both acute and recent infarction as well as unstable angina. This lesion probably represents either a disrupted atherosclerotic plaque or a partially occlusive or lysed thrombus, or both. The predominance of this morphology in both unstable angina and acute infarction suggests a possible link between these two conditions. Unstable angina and myocardial infarction may form a continuous spectrum with the clinical outcome dependent on the subsequent change in coronary supply relative to myocardial demand.

AB - It has previously been shown that analysis of coronary morphology can separate unstable from stable angina. An eccentric stenosis with a narrow neck or irregular borders, or both, is very common in patients who present with acute unstable angina, whereas it is rare in patients with stable angina. To extend these observations to myocardial infarction, the coronary morphology of 41 patients with acute or recent infarction and nontotally occluded infarct vessels was studied. For all patients, 27 (66%) of 41 infarct vessels contained this eccentric narrowing, whereas only 2 (11%) of 18 noninfarct vessels with narrowing of 50 to less than 100% had this lesion (p < 0.001). In addition, a separate group of patients with acute myocardial infarction who underwent intracoronary streptokinase infusion were also analyzed in similar fashion. Fourteen (61%) of 23 infarct vessels contained this lesion after streptokinase infusion compared with 1 (9%) of 11 noninfarct vessels with narrowing of 50 to less than 100% (p < 0.01). Therefore, an eccentric coronary stenosis with a narrow neck or irregular borders, or both, is the most common morphologic feature on angiography in both acute and recent infarction as well as unstable angina. This lesion probably represents either a disrupted atherosclerotic plaque or a partially occlusive or lysed thrombus, or both. The predominance of this morphology in both unstable angina and acute infarction suggests a possible link between these two conditions. Unstable angina and myocardial infarction may form a continuous spectrum with the clinical outcome dependent on the subsequent change in coronary supply relative to myocardial demand.

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