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Published on: April 25, 2014
Angiographic lesion severity and subsequent myocardial infarction
Tarique Zaman1, Shikhar Agarwal, Abdel G Anabtawi
1Jacobi Medical Center, Bronx, NY, USA.
Insights
The time interval between coronary angiography and myocardial infarction (MI) significantly impacts lesion severity assessment. Lesions leading to ST-elevation MI (STEMI) within 3 months showed greater stenosis than those occurring later.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Previous studies on coronary lesion severity preceding myocardial infarction (MI) often did not account for the time interval between angiography and the clinical event.
- The relationship between baseline stenosis severity and the timing of subsequent ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) requires further clarification.
Purpose of the Study:
- To determine the angiographic severity of coronary lesions causing STEMI and NSTEMI.
- To evaluate the impact of the time interval from initial angiogram to the clinical event on lesion severity and MI outcome.
Main Methods:
- Retrospective analysis of 84 NSTEMI and 41 STEMI patients with prior angiograms (2003-2010).
- Quantitative coronary angiography re-analysis and clinical data extraction from medical records.
- Comparison of lesion severity based on intervals >3 months versus ≤3 months before the MI event.
Main Results:
- Similar to prior research, a majority of STEMI (71%) and NSTEMI (63%) cases occurred with <50% baseline stenosis when the interval was >3 months.
- Lesions leading to STEMI within ≤3 months showed significantly higher stenosis (59% ± 31%) compared to those occurring >3 months prior (36% ± 21%, p=0.02).
- Over half (57%) of STEMI-causing lesions evaluated ≤3 months before the event had >50% stenosis.
Conclusions:
- The time elapsed between coronary angiography and the onset of MI is a critical factor in assessing lesion severity.
- High-grade coronary stenosis identified within 3 months of an event may be a significant predictor of subsequent STEMI.
- Angiographic findings require careful interpretation considering the temporal relationship to the clinical manifestation of MI.
Abstract:
We sought to determine the angiographic severity of coronary lesions leading to ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) with a focus on determining the impact of interval from initial angiogram to subsequent clinical event. In the late 1980s angiographic data on lesion characteristics that culminated in STEMI and NSTEMI were obtained from angiograms obtained several months before MI. It is not clear whether the conclusions on lesion severity would be different if elapsed interval from baseline angiogram to clinical event was factored in the analysis. From 2003 through 2010, we identified 84 patients with NSTEMI and 41 patients with STEMI in vessels without previous intervention. These patients had ≥1 previous angiographic study at our center. Angiograms were reanalyzed with quantitative coronary angiography, and relevant clinical data were obtained from medical records. Similar to previous studies, 71% of patients with STEMI and 63% of patients with NSTEMI had <50% baseline stenosis at the culprit site when the interval from initial angiogram to MI was >3 months. Interestingly, lesions that led to STEMI ≤3 months after evaluation were more severe than those leading to STEMI in >3 months (59 ± 31% vs 36 ± 21%, p = 0.02) with 57% of lesions having >50% stenosis. Although most MIs occurred at sites that did not have significant obstruction when examined >3 months before MI, most baseline lesions showed significant luminal narrowing when examined ≤3 months before STEMI. In conclusion, high-grade coronary stenosis may be an important predictor of STEMI in subsequent months.
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