title: Multiple complex coronary plaques in patients with acute myocardial infarction.
abstract: BACKGROUND
  Acute myocardial infarction is believed to be caused by rupture of an unstable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and that therefore result in multiple unstable lesions.
  
  
  METHODS
  To document the presence of multiple unstable plaques in patients with acute myocardial infarction and determine their influence on outcome, we analyzed angiograms from 253 patients for complex coronary plaques characterized by thrombus, ulceration, plaque irregularity, and impaired flow.
  
  
  RESULTS
  Single complex coronary plaques were identified in 153 patients (60.5 percent) and multiple complex plaques in the other 100 patients (39.5 percent). As compared with patients with single complex plaques, those with multiple complex plaques were less likely to undergo primary angioplasty (86.0 percent vs. 94.8 percent, P = 0.03) and more commonly required urgent bypass surgery (27.0 percent vs. 5.2 percent, P < or = 0.001). During the year after myocardial infarction, the presence of multiple complex plaques was associated with an increased incidence of recurrent acute coronary syndromes (19.0 percent vs. 2.6 percent, P < or = 0.001); repeated angioplasty (32.0 percent vs. 12.4 percent, P < or = 0.001), particularly of non-infarct-related lesions (17.0 percent vs. 4.6 percent, P < or = 0.001); and coronary-artery bypass graft surgery (35.0 percent vs. 11.1 percent, P < or = 0.001).
  
  
  CONCLUSIONS
  Patients with acute myocardial infarction may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. Plaque instability may be due to a widespread process throughout the coronary vessels, which may have implications for the management of acute ischemic heart disease.
authors.affiliation: Division of Cardiology, William Beaumont Hospital, Royal Oak, Mich 48073-6769, USA. jgoldstein@beaumont.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: D
authors.initials: D
authors.lastname: Demetriou
authors.forename: C L
authors.initials: CL
authors.lastname: Grines
authors.forename: M
authors.initials: M
authors.lastname: Pica
authors.forename: M
authors.initials: M
authors.lastname: Shoukfeh
authors.forename: W W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome