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Coronary arteriographic findings in acute transmural myocardial infarction
Insights
Coronary thrombosis is present in 80% of patients with early myocardial infarction (MI). This finding decreases significantly within 24 hours, suggesting thrombus formation is key in acute MI development.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Acute myocardial infarction (MI) is a leading cause of mortality worldwide.
- Understanding the early pathological mechanisms of MI is crucial for timely intervention.
- Coronary thrombosis is a suspected primary event in acute MI, but its prevalence and timing require further elucidation.
Purpose of the Study:
- To characterize coronary arteriographic findings in early transmural myocardial infarction.
- To determine the prevalence of coronary thrombosis using arteriography within 24 hours of symptom onset.
- To investigate the relationship between the timing of intervention and the presence of coronary thrombosis.
Main Methods:
- Coronary arteriography and left ventriculography were performed in 517 patients with transmural MI.
- Patients were categorized into three groups based on symptom onset to intervention time: within 6 hours, 6-12 hours, and 12-24 hours.
- Arteriographic evidence of coronary thrombosis was identified by contrast material staining, retention, and filling defects.
Main Results:
- Coronary thrombosis was detected in approximately 80% of patients studied within 6 hours of symptom onset.
- The prevalence of both total coronary occlusion and coronary thrombosis significantly decreased in patients studied between 6-12 hours and 12-24 hours.
- Arteriographic characteristics of thrombus included persistent staining, contrast retention, and intracoronary filling defects, particularly in non-total occlusions.
Conclusions:
- Coronary thrombosis is a highly prevalent finding in the early hours (within 6 hours) of transmural myocardial infarction.
- The decreasing prevalence of thrombosis over time suggests thrombus formation with subsequent recanalization or coronary spasm plays a role in MI evolution.
- Coronary thrombosis appears to be the final common pathway in the majority of patients transitioning from chronic coronary disease to acute myocardial infarction.
Abstract:
To describe the coronary arteriographic findings during early transmural myocardial infarction and to define the prevalence of coronary thrombosis by arteriography, we performed coronary arteriography and left ventriculography within 24 hours from symptom onset of transmural myocardial infarction in 517 patients. The coronary arteriographic findings included total and nontotal coronary occlusion with and without coronary thrombosis. Coronary spasm or severe stenosis in the affected vessel were discovered in a minority of patients. The coronary arteriographic characteristics of thrombus included persistent staining of intraluminal material by the contrast material, local retention of the contrast agent in the involved coronary artery, and intracoronary filling defect occurring mostly in nontotal occlusion. Of the 517 patients, 368 were studied within 6 hours of symptom onset, 85 within 6-12 hours and 64 within 12-24 hours. There was a systematic difference between total coronary occlusion and coronary thrombosis in each group. This was determined by arteriographic findings (judged positive or negative) relative to surgical findings. Both total coronary occlusion and coronary thrombosis were more prevalent in the early treatment (within 6 hours from symptom onset) group. Total occlusion and thrombosis declined significantly in the 6-12- and 12-24-hour groups. These data suggest that thrombus is encountered by arteriography and confirmed by surgical exploration within the first 6 hours from symptom onset of transmural infarction in approximately 80% of patients. Coronary thrombosis by coronary arteriography decreases in parallel with total coronary occlusion during the first 24 hours after acute transmural infarction, suggesting that coronary spasm or thrombus formation with subsequent recanalization are important in the evolution of transmural infarction. Despite many factors involved in the pathogenesis of transmural myocardial infarction, coronary thrombosis appears to be the final common pathway converting chronic coronary disease to acute myocardial infarction in the majority of patients.