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Angioscopic identification of coronary thrombus in patients with postinfarction angina
H Tabata1, K Mizuno, K Arakawa
1First Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Insights
Intracoronary thrombus is common in postinfarction angina, detected more effectively by coronary angioscopy than angiography. This finding suggests thrombus may be a key cause of this high-risk condition.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Postinfarction angina (PIA) is a high-risk condition previously studied solely by angiography.
- Coronary angioscopy allows direct visualization of intracoronary changes, prompting a reevaluation of PIA's pathogenesis.
- PIA is associated with increased risk of sudden death, recurrent angina, and refractory angina.
Purpose of the Study:
- To determine the prevalence of intracoronary thrombus in patients with postinfarction angina.
- To identify associated anatomic abnormalities in patients with postinfarction angina.
- To compare the diagnostic capabilities of coronary angioscopy and angiography in detecting intracoronary thrombus.
Main Methods:
- Fifty-one patients with acute myocardial infarction underwent cardiac catheterization.
- Coronary angiography followed by coronary angioscopy was performed in 17 patients with and 34 without postinfarction angina.
- Patients were assessed at a mean of 10.2 days (with PIA) and 15.7 days (without PIA) post-myocardial infarction.
Main Results:
- Intracoronary thrombus was observed in all 17 patients with postinfarction angina (100%) versus 5 of 34 patients without (14.7%, p < 0.01).
- No significant differences were found in the degree of stenosis, number of diseased vessels, collateral flow, therapy, or risk factors between groups.
- Coronary angioscopy demonstrated a significantly higher frequency of thrombus compared to coronary angiography.
Conclusions:
- Intracoronary thrombus is universally present in postinfarction angina and may be the primary pathogenic factor.
- Coronary angioscopy is significantly more sensitive than coronary angiography for detecting coronary thrombus.
- These findings highlight the importance of thrombus visualization in understanding and managing postinfarction angina.
Objectives:
The purpose of this study was to determine the prevalence of intracoronary thrombus and associated anatomic abnormalities in patients with postinfarction angina using coronary angioscopy and angiography.
Background:
Postinfarction angina, previously studied by angiographic methods only, identifies patients at high risk for sudden death, recurrent angina and refractory angina. The recent development of coronary angioscopy, which permits direct observation of a thrombus or atheroma and is especially used for the detection of intraluminal changes, encourages a reexamination of the pathogenesis of postinfarction angina.
Methods:
Fifty-one consecutive patients with a diagnosis of acute myocardial infarction underwent cardiac catheterization. Coronary angiography followed immediately by coronary angioscopy was performed in 17 patients with and 34 without postinfarction angina during the same period of time (10.2 +/- 3.7 or 15.7 +/- 5.5 days [mean +/- SD]) after the onset of acute myocardial infarction.
Results:
The frequency of thrombus, as observed by angioscopy, was significantly higher in patients with than without postinfarction angina (17 of 17 vs. 5 of 34, respectively, p < 0.01). There were no significant differences between groups with respect to degree of stenosis in the infarct-related artery, number of vessels with significant stenosis, presence of collateral flow, type of therapy and risk factors.
Conclusions:
Infarct-related artery thrombus is universally present in postinfarction angina and may be the primary pathogenic factor. Angioscopy is much more sensitive than coronary angiography for the detection of coronary thrombus.