title: Angiographic demonstration of a common link between unstable angina pectoris and non-Q-wave acute myocardial infarction.
abstract: 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 less than 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 ischemia-related 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 less than 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.
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: J A
authors.initials: JA
authors.lastname: Ambrose
authors.forename: C E
authors.initials: CE
authors.lastname: Hjemdahl-Monsen
authors.forename: S
authors.initials: S
authors.lastname: Borrico
authors.forename: R
authors.initials: R
authors.lastname: Gorlin
authors.forename: V
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies