Evidence of Multifocal Activity of Coronary Disease in Patients With Acute Myocardial Infarction
Male
Analysis of Variance
plaque; angina; myocardial infarction; remodeling
Myocardial Infarction
Coronary Artery Disease
Middle Aged
Coronary Angiography
Angina Pectoris
3. Good health
03 medical and health sciences
0302 clinical medicine
Case-Control Studies
Disease Progression
Humans
Female
Prospective Studies
DOI:
10.1161/01.cir.96.4.1145
Publication Date:
2012-06-12T00:41:02Z
AUTHORS (7)
ABSTRACT
Background
Destabilization of the fibrous cap facilitates plaque rupture, thrombus formation, and myocardial infarction. Because systemic stimuli, such as lipoproteins, infectious agents, and autoantigens, may incite this reaction, one may wonder whether disruption mechanisms are only local or systemic and infarction is caused by an arbitrary plaque event or by a systemic, acute activity of the coronary disease.
Methods and Results
Early (3 to 5 days) and late (1 month) peri-infarction coronary angiographic data in 23 patients with first infarction were compared with that in 23 similar patients, with angiography performed because of stable angina and repeated after 1 month before angioplasty. Nonculprit lesion changes at the narrowest point defined progression or regression when exceeding 0.27 mm. In patients with recent infarction we found that 16 had progression, 4 had regression, 1 had both, 2 were steady (values in patients with stable angina being 2 [
P
<.001], 1 [NS], 0 [NS], and 20 [
P
<.001]); 27 lesions were infarct related; 17 of the 45 nonculprit lesions progressed and 5 regressed (values in stable angina being 2 [
P
<.001] and 1 [
P
<.05] out of 78); minimal diameter reduction of progressing stenoses averaged 0.39 mm; lumen increase of regressing lesions averaged 0.30 mm; 3 patients developed interim rest angina associated with progression of a nonculprit lesion.
Conclusions
A greater proportion of subjects and lesions with progression or regression (in infarction versus stable angina) supports the hypothesis that infarction is a hallmark of systemic coronary disease activity. Changes might vary according to the “maturation” stage of an atheroma, and maximal expression would be at the level of the offending plaque. Shrinkage, thrombolysis, or vascular remodeling would determine the residual plaque morphology.
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