title: Angiographic morphology in unstable angina pectoris.
abstract: Complex morphology occurs frequently in unstable angina; however, its relation to symptomatic presentation, timing of angiography and hospital outcome has not been investigated. Accordingly, coronary angiography was performed 5 +/- 2 days after qualifying rest pain in 101 consecutive patients presenting with acute coronary insufficiency (n = 67) or crescendo angina (n = 34). Significant coronary artery disease was defined as any greater than or equal to 50% stenosis, and complex morphology as any stenosis with irregularity, overhang or thrombus. Eight of the 67 patients presenting with acute coronary insufficiency later proved to have a myocardial infarction as the qualifying event (creatine kinase twice normal with elevation of MB fraction). There were no myocardial infarctions in the crescendo angina group. Complex morphology occurred in 61% of patients. Thrombus alone occurred in 27% of patients with unstable angina without myocardial infarction, with similar frequencies between the 2 clinical groups. In contrast, intraluminal thrombi were identified in 78% of patients with acute coronary insufficiency who later proved to have a myocardial infarction as the qualifying event. The need for urgent catheterization (less than 48 hours) prompted by recurrent symptoms was associated with the angiographic findings of intraluminal thrombus (46%) and complex morphology (83%). The presence of complex morphology and intracoronary thrombus was associated with a higher incidence of in-hospital cardiac events, i.e., revascularization, myocardial infarction and death, independent of the incidence of multivessel disease.
authors.affiliation: Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: A E
authors.initials: AE
authors.lastname: Williams
authors.forename: M R
authors.initials: MR
authors.lastname: Freeman
authors.forename: R J
authors.initials: RJ
authors.lastname: Chisholm
authors.forename: N L
authors.initials: NL
authors.lastname: Patt
authors.forename: P W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D000789:Angina, Unstable / Q000000981:diagnostic imaging*; D000792:Angiography; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging; D013997:Time Factors