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Correlation of angiographic morphology and clinical presentation in unstable angina

G Dangas1, R Mehran, S Wallenstein

  • 1Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA.

Journal of the American College of Cardiology
|March 1, 1997
PubMed

Insights

Severe unstable angina (UA) presentations, including rest pain and refractory or postinfarction angina, are linked to complex coronary lesions and intracoronary thrombus (ICT). This finding highlights the importance of angiographic assessment in unstable angina patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Unstable angina (UA) is frequently caused by acute thrombosis on disrupted atherosclerotic plaques.
  • Complex and thrombotic lesions are common in UA and linked to poorer outcomes.
  • Braunwald classification severity levels (III, C, c) assess clinical presentation but lack direct correlation with lesion complexity and thrombus.

Purpose of the Study:

  • To correlate angiographically identified complex coronary lesions and intracoronary thrombus (ICT) with the severity of clinical presentation in unstable angina (UA).
  • To investigate the relationship between specific Braunwald classification levels and angiographic findings in UA patients.

Main Methods:

  • Prospective study of 284 UA patients undergoing cardiac catheterization.
  • Angiograms interpreted by a blinded expert, classifying culprit lesions as simple or complex (including complex morphology, ICT, or total occlusion).
  • Quantitative lesion analysis, Thrombolysis in Myocardial Infarction (TIMI) flow assessment, and logistic regression analyses were performed.

Main Results:

  • Braunwald Class III was associated with complex lesions (p=0.04) and reduced TIMI flow (p=0.03).
  • Class C angina correlated with complex lesions (p=0.04), ICT (p=0.005), and reduced TIMI flow (p=0.03).
  • Class c angina was associated with ICT (p=0.02). Quantitative stenosis degree did not correlate with Braunwald class.

Conclusions:

  • Severe clinical presentations in unstable angina (rest pain, refractory, or postinfarction angina) are strongly associated with complex coronary lesions.
  • Angiographically detected intracoronary thrombus (ICT) and decreased TIMI flow are specifically linked to these severe UA presentations.
  • These findings emphasize the clinical significance of detailed angiographic evaluation in managing unstable angina.
Abstract

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