Angiographic progression of coronary artery disease and the development of myocardial infarction

Department of Medicine, New York Cardiac Center, Mount Sinai Medical Center, New York 10029.

There are few data on angiographic coronary artery anatomy in patients whose coronary artery disease progresses to myocardial infarction. In this retrospective analysis, progression of coronary artery disease between two cardiac catheterization procedures is described in 38 patients: 23 patients (Group I) who had a myocardial infarction between the two studies and 15 patients (Group II) who presented with one or more new total occlusions at the second study without sustaining an intervening infarction. In Group I the median percent stenosis on the initial angiogram of the artery related to the infarct at restudy was significantly less than the median percent stenosis of lesions that subsequently were the site of a new total occlusion in Group II (48 versus 73.5%, p less than 0.05). In the infarct-related artery in Group I, only 5 (22%) of 23 lesions were initially greater than 70%, whereas in Group II, 11 (61%) of 18 lesions that progressed to total occlusion were initially greater than 70% (p less than 0.01). In Group I, patients who developed a Q wave infarction had less severe narrowing at initial angiography in the subsequent infarct-related artery (34%) than did patients who developed a non-Q wave infarction (80%) (p less than 0.05). Univariate and multivariate analysis of angiographic and clinical characteristics present at initial angiography in Group I revealed proximal lesion location as the only significant predictor of evolution of lesions greater than or equal to 50% to infarction. This retrospective study suggests that myocardial infarction frequently develops from previously nonsevere lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

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				D. A. Zvara Treatment of Perioperative Myocardial Ischemia Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 2001; 5(2): 166 - 183. [Abstract] [PDF]

				G. J. W. Bech, B. De Bruyne, N. H.J. Pijls, E. D. de Muinck, J. C.A. Hoorntje, J. Escaned, P. R. Stella, E. Boersma, J. Bartunek, J. J. Koolen, et al. Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis : A Randomized Trial Circulation, June 19, 2001; 103(24): 2928 - 2934. [Abstract] [Full Text] [PDF]

				T. Sharir, G. Germano, X. Kang, H. C. Lewin, R. Miranda, I. Cohen, R. D. Agafitei, J. D. Friedman, and D. S. Berman Prediction of Myocardial Infarction Versus Cardiac Death by Gated Myocardial Perfusion SPECT: Risk Stratification by the Amount of Stress-Induced Ischemia and the Poststress Ejection Fraction J. Nucl. Med., June 1, 2001; 42(6): 831 - 837. [Abstract] [Full Text] [PDF]

				F. Ledru, P. Ducimetiere, S. Battaglia, D. Courbon, F. Beverelli, L. Guize, J.-L.e. Guermonprez, and B. Diebold New diagnostic criteria for diabetes and coronary artery disease: insights from an angiographic study J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1543 - 1550. [Abstract] [Full Text] [PDF]

				S. S. Lin, M. S. Lauer, C. R. Asher, D. M. Cosgrove, E. Blackstone, J. D. Thomas, and M. J. Garcia Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 894 - 901. [Abstract] [Full Text] [PDF]

				M. Aikawa and P. Libby Vascular inflammation and activation: new targets for lipid lowering Eur. Heart J. Suppl., May 1, 2001; 3(suppl_B): B3 - B11. [Abstract] [PDF]

				J. Candell-Riera, O. Pereztol-Valdés, C. Santana-Boado, M. Missorici, G. Oller-Martínez, S. Aguadé-Bruix, J. Castell-Conesa, M. Simó, M. J. Díez-Castro, and J. Soler-Soler Relationship Between the Location of the Most Severe Myocardial Perfusion Defects, the Most Severe Coronary Artery Stenosis, and the Site of Subsequent Myocardial Infarction J. Nucl. Med., April 1, 2001; 42(4): 558 - 563. [Abstract] [Full Text]

				G.e. Helft, S. G. Worthley, V. Fuster, A. G. Zaman, C. Schechter, J. I. Osende, O. J. Rodriguez, Z. A. Fayad, J. T. Fallon, and J. J. Badimon Atherosclerotic aortic component quantification by noninvasive magnetic resonance imaging: an in vivo study in rabbits J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1149 - 1154. [Abstract] [Full Text] [PDF]