Serial angiography in patients with acute coronary syndromes: effect of antithrombotic therapy on angiographic lesion severity.
BACKGROUND
Patients presenting with acute coronary syndromes (ACS) commonly have a responsible culprit coronary lesion. There is limited data on the natural history of this culprit lesion in the short term and whether there is a change in morphology of this lesion in the days following presentation. Furthermore, the effect of antithrombotic therapy on this process is unknown.


METHODS
Sixty-eight patients presenting with ACS had their diagnostic study performed at our institution and had coronary angioplasty performed a few days later at a different hospital. Culprit lesion characteristics including minimum luminal diameter (MLD) and percentage diameter stenosis were determined on each occasion.


RESULTS
Acute myocardial infarction patients (n=14) had improved culprit lesion characteristics at angioplasty compared to baseline (diameter stenosis 78.9% versus 62.4%, p<0.01). Similarly, patients presenting with unstable angina (UA) or non-ST elevation myocardial infarction (non-STEMI) (n=54) had improved diameter stenosis (78.0% versus 72.7%, p<0.001). The change in MLD was greater in MI patients than UAP/non-STEMI patients (0.6mm versus 0.16mm, p<0.01).


CONCLUSIONS
Treatment of ACS patients with aspirin with anticoagulant therapy followed by delayed intervention results in angiographic improvement in lesion severity which may provide a more favourable environment in which to undertake percutaneous coronary intervention.
Prasan
Ananth M
AM
Department of Cardiology, Concord Repatriation Hospital, Sydney, NSW, Australia.
Bhagwandeen
Rohan
R
Solanki
Victor J
VJ
Freedman
S Benjamin
SB
Brieger
David
D
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000188:drug therapy / Q000473:pathology*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*
D005343:Fibrinolytic Agents; D001241:Aspirin