Circulation, Vol 78, 1157-1166, Copyright © 1988 by American Heart Association
WC Little, M Constantinescu, RJ Applegate, MA Kutcher, MT Burrows, FR Kahl and WP Santamore
To help determine if coronary angiography can predict the site of a future
coronary occlusion that will produce a myocardial infarction, the coronary
angiograms of 42 consecutive patients who had undergone coronary
angiography both before and up to a month after suffering an acute
myocardial infarction were evaluated. Twenty-nine patients had a newly
occluded coronary artery. Twenty-five of these 29 patients had at least one
artery with a greater than 50% stenosis on the initial angiogram. However,
in 19 of 29 (66%) patients, the artery that subsequently occluded had less
than a 50% stenosis on the first angiogram, and in 28 of 29 (97%), the
stenosis was less than 70%. In every patient, at least some irregularity of
the coronary wall was present on the first angiogram at the site of the
subsequent coronary obstruction. In only 10 of the 29 (34%) did the
infarction occur due to occlusion of the artery that previously contained
the most severe stenosis. Furthermore, no correlation existed between the
severity of the initial coronary stenosis and the time from the first
catheterization until the infarction (r2 = 0.0005, p = NS). These data
suggest that assessment of the angiographic severity of coronary stenosis
may be inadequate to accurately predict the time or location of a
subsequent coronary occlusion that will produce a myocardial infarction.
ARTICLES
Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?
Department of Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
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