Correlation between clinical and morphologic findings in unstable angina

Area of Science:

• Cardiology
• Pathology

Background:

• Published reports on thrombus prevalence in unstable angina show conflicting results.
• These discrepancies may stem from the inclusion of diverse clinical patient subsets in different studies.

Purpose of the Study:

• To investigate if varying clinical subsets within unstable angina explain discrepant findings on thrombus prevalence.
• To correlate patient clinical characteristics with coronary angiography, intravascular ultrasound, and atherectomy specimen findings.

Main Methods:

• Studied 58 unstable angina patients (Braunwald class B) undergoing coronary angiography and intervention.
• Utilized intravascular ultrasound (n=43) and histopathologic analysis of atherectomy specimens (n=38).
• Correlated clinical data (e.g., ECG findings) with angiographic and histopathologic lesion characteristics.

Main Results:

• Complex lesion morphology was seen in 53% of patients, unrelated to clinical subsets.
• Patients with negative T waves on baseline ECG showed a higher incidence of acute coronary lesions (47% overall).
• Negative T waves on baseline ECG were the sole predictor of acute coronary lesions (p=0.03) in multivariate analysis.

Conclusions:

• Patient subsets within unstable angina exhibit distinct morphologic features and varying incidences of acute coronary lesions.
• The presence of negative T waves on baseline ECG is a significant indicator of acute coronary lesions.
• These findings help explain the variability in reported thrombus prevalence and its role in unstable angina.