TY - JOUR
T1 - Angiographic demonstration of a common link between unstable angina pectoris and non-Q wave acute myocardial infarction
AU - Ambrose, John A.
AU - Hjemdahl-Monsen, Craig E.
AU - Borrico, Susan
AU - Gorlin, Richard
AU - Fuster, Valentin
N1 - Funding Information:
From the Department of Internal Medicine, the Division of Cardiology, Mount Sinai Medical Center and Mount Sinai Hospital, New York, New York. This study was supported by the New York Cardiac Center, Englewood Cliffs, New Jersey. Manuscript received August 31, 1987; revised manuscript received October 9,1987, and accepted October 13. Address for reprints: John A. Ambrose, MD, Division of Cardiology, Mount Sinai Hospital, One Gustave L. Levy Place, New York, New York 10029.
PY - 1988/2/1
Y1 - 1988/2/1
N2 - The coronary morphology of ischemia-related arteries in unstable angina and Q-wave acute myocardial infarction (AMI) has been described. An eccentric stenosis with overhanging edges or irregular borders (type II eccentric) was seen in most lesions <100% occluded and probably represented plaque disruption, nonocclusive thrombus or both. The coronary morphology of non-Q AMI has not been described. Thus, the angiograms of 106 consecutive patients catheterized with either unstable angina (n = 73) or non-Q AMI (n = 33) and an identifiable ischemia-related artery were prospectively analyzed. Non-Q AMI was diagnosed by prolonged chest pain and new and persistent ST-T changes or creatine phosphokinase twice the normal level. The results showed a higher incidence of total occlusion of the ischemia-related artery in non-Q AMI (21%) compared with unstable angina (8%) (p = 0.1). The coronary morphology of nonoccluded ischemiarelated arteries was similar with preponderance of type II eccentric lesions in both unstable angina and non-Q AMI. These lesions were found in 65% of ischemia-related arteries in non-Q AMI but were uncommon (3%) in nonischemia-related arteries with significant (50% to 100%) stenoses. Therefore, the type II eccentric lesion is a sensitive and specific marker of <100% occluded ischemia-related arteries in both unstable angina and non-Q AMI. These similarities in coronary morphology suggest a similar pathogenesis, which, as previously suggested, may relate to plaque disruption with or without thrombus. Unstable angina and non-Q AMI appear to represent part of a continuous spectrum of acute coronary artery disease. Further, the management of patients with non-Q AMI should be similar to patients with unstable angina and possibly include anticoagulation and consideration for early catheterization.
AB - The coronary morphology of ischemia-related arteries in unstable angina and Q-wave acute myocardial infarction (AMI) has been described. An eccentric stenosis with overhanging edges or irregular borders (type II eccentric) was seen in most lesions <100% occluded and probably represented plaque disruption, nonocclusive thrombus or both. The coronary morphology of non-Q AMI has not been described. Thus, the angiograms of 106 consecutive patients catheterized with either unstable angina (n = 73) or non-Q AMI (n = 33) and an identifiable ischemia-related artery were prospectively analyzed. Non-Q AMI was diagnosed by prolonged chest pain and new and persistent ST-T changes or creatine phosphokinase twice the normal level. The results showed a higher incidence of total occlusion of the ischemia-related artery in non-Q AMI (21%) compared with unstable angina (8%) (p = 0.1). The coronary morphology of nonoccluded ischemiarelated arteries was similar with preponderance of type II eccentric lesions in both unstable angina and non-Q AMI. These lesions were found in 65% of ischemia-related arteries in non-Q AMI but were uncommon (3%) in nonischemia-related arteries with significant (50% to 100%) stenoses. Therefore, the type II eccentric lesion is a sensitive and specific marker of <100% occluded ischemia-related arteries in both unstable angina and non-Q AMI. These similarities in coronary morphology suggest a similar pathogenesis, which, as previously suggested, may relate to plaque disruption with or without thrombus. Unstable angina and non-Q AMI appear to represent part of a continuous spectrum of acute coronary artery disease. Further, the management of patients with non-Q AMI should be similar to patients with unstable angina and possibly include anticoagulation and consideration for early catheterization.
UR - http://www.scopus.com/inward/record.url?scp=0023788838&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(88)90924-1
DO - 10.1016/0002-9149(88)90924-1
M3 - Article
C2 - 3341201
AN - SCOPUS:0023788838
SN - 0002-9149
VL - 61
SP - 244
EP - 247
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -