Coronary Angiographic Findings and In-Hospital Outcome of Aggressive Treatment in Impending Myocardial Infarction

Abstract

The influence of coronary angiographic findings and treatment on clinical outcome was determined in 104 patients with impending myocardial infarction (unstable angina with prolonged chest pain and persistent electrocardiographic changes on admission). Coronary arteriography was performed on day one (aggressive strategy) in 50 patients and following medical treatment (conservative strategy) in 48 patients, of whom 40 were unstable. Six elderly patients were treated medically without angiography. A complex eccentric morphology of the coronary vessels was the most common finding in both groups, but the incidence of intracoronary thrombus was significantly higher in the aggressive strategy group (78%) and in unstable patients (77%) compared with patients controlled medically (24%). Severe multivessel disease was also common in refractory patients without thrombus. Percutaneous transluminal coronary angioplasty was less successful and produced more distal emboli in patients with thrombus. Emergency intervention was applied to 90% of the aggressive strategy group-it failed to improve the in-hospital outcome, but shortened hospitalization significantly. Elderly patients treated medically without angiography had the highest mortality. We concluded that intracoronary thrombus plays a major role in the pathogenesis of impending infarction, and that the majority of such patients cannot be stabilized medically. An aggressive strategy can be applied safely to impending infarction and will shorten hospitalization. © 1992, The Japanese Circulation Society. All rights reserved.