Circulation, Vol 80, 17-23, Copyright © 1989 by American Heart Association
MR Freeman, AE Williams, RJ Chisholm and PW Armstrong
In 78 consecutive patients with unstable angina, we performed coronary
angiography randomized to either the first day of presentation or later
during the hospital admission to assess the frequency of intracoronary
thrombus and complex coronary morphology relative to the time of
symptomatic presentation and the impact of these angiographic features on
outcome. Early angiography (17 +/- 6 hours) was performed in 42 patients
and late angiography in 36 patients (5.7 +/- 2.1 days). Twelve patients
randomized to late angiography required urgent cardiac catheterization 3.9
+/- 2.2 days after admission. Coronary thrombi were present in 43% (18 of
42) of early angiography patients and in 38% (14 of 36) of late angiography
patients (p = NS). Only 21% (five of 24) late elective angiography patients
had coronary thrombi, but 75% (nine of 12) of late urgent angiography
patients had thrombi (p less than 0.05 vs. both early and late elective
angiography patients). There was no difference in the frequency of complex
coronary morphology among patients randomized to early angiography (42%, or
15 of 36), late urgent angiography (42%, or five of 12), and late elective
angiography (38%, or nine of 24). Cardiac events (death, myocardial
infarction, and urgent revascularization) were more frequent in the
patients with coronary thrombus (73%, or 23 of 32), complex coronary
morphology (55%, or 16 of 29), and multiple-vessel disease (58%, or 29 of
50) than in the patients without these angiographic features (17%, or eight
of 46; 31%, or 15 of 49; and 7%, or two of 28, respectively; all p less
than 0.05). Multiple regression analysis demonstrated that coronary
thrombus was the best angiographic predictor of cardiac events. Thus,
angiographic detection of intracoronary thrombi varies according to the
temporal relation between angiography and chest pain at rest.
ARTICLES
Intracoronary thrombus and complex morphology in unstable angina. Relation to timing of angiography and in-hospital cardiac events
Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
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