Morphology of left anterior descending coronary territory lesions as a predictor of anterior myocardial infarction: A CASS registry study

Abstract

Despite a growing awareness of the correlation of coronary artery stenoses morphology with clinical syndromes, no comprehensive, prospective analysis of the implications of stenosis morphology on risk of myocardial infarction has been reported. Angiograms from 118 patients, representative of the 4.9% of medically treated Coronary Artery Surgery Study (CASS) patients who during subsequent 3 year follow-up study had an anterior myocardial infarction, were matched on the basis of arteriographic anatomy and disease with 141 patients who did not have an anterior infarction. Angiograms from these 259 patients with 557 left anterior descending artery stenoses were reviewed without knowledge of clinical outcome. Conditional regression analyses were performed to determine the importance of stenosis morphology, relative to computer-determined stenosis severity and other clinical variables, in the prediction of risk of infarction. Univariate analysis revealed luminal roughness (odds ratio 4.5; p = 0.001) and lesion length (odds ratio 1.7 per unit length; p = 0.007) to be highly correlated with future risk of infarction. Multivariate analysis revealed left anterior descending artery percent stenosis greater than or equal to 50%, lesion roughness, left circumflex artery stenosis and smoking, in that order, to be predictive of anterior myocardial infarction, whereas 22 other morphologic variables were not independently predictive of outcome. The importance of stenosis roughness may relate to its propensity for thrombogenesis and should be considered in clinical decision making.

Plasma Matrix Metalloproteinase-8 Concentrations are Associated With the Presence and Severity of Coronary Artery Disease

“…Complex coronary lesions detected by angiography are known to be associated with plaque vulnerability 12,19 and to be predictive of coronary events, such as unstable angina and myocardial infarction. 12,20,21 Complex lesions are common in unstable angina and have been reported in 10-20% of patients with stable angina. 12 In our study, patients with acute myocardial infarction or unstable angina were excluded, but complex lesions were found in 23% of the patients with CAD.…”

Expression of Neutrophil Gelatinase–Associated Lipocalin in Atherosclerosis and Myocardial Infarction

“…[1][2][3][4] Current evidence instead suggest that physical disruption of atherosclerotic plaques triggers thrombus formation, which may lead to MI. [5][6][7] The 2 major precipitating factors of thrombus formation are disruption of the plaque cap and erosion of its endothelial lining.…”

A Possible Association Between Coronary Plaque Instability and Complex Plaques in Abdominal Aorta

“…2,3 Although angiographic complex coronary lesions are seen in 10% to 20% of patients with stable angina, 2 such lesions are known to be common in acute coronary syndrome and to be predictive of coronary events. 2,4,5 Recently, complex plaques in carotid arteries were reported to be more prevalent in patients with unstable angina than in those with stable angina, suggesting a link between coronary and carotid plaque instability. 6 Plaque instability in patients with coronary artery disease (CAD) may not be confined to coronary arteries, but it may also involve other arteries.…”