ANGIOGRAPHIC CORONARY-ARTERY LESION MORPHOLOGY AND PATHOGENETIC MECHANISMS OF MYOCARDIAL-ISCHEMIA IN STABLE AND UNSTABLE CORONARY-ARTERY DISEASE SYNDROMES

The angiographic morphology of coronary artery stenoses was studied in 160 patients referred for diagnostic coronary arteriography. Three groups of patients were studied: 60 patients with stable angina, 78 patients with unstable angina and 22 patients with a recent myocardial infarction. Complex lesions were more frequently observed in patients with unstable angina (59%, p < 0.001) and in patients with a recent myocardial infarction (54%, p < 0.05) then in patients with stable angina (25%). Angiographic signs suggestive for the presence of intravascular thrombi were almost exclusively observed in the patients with unstable angina (34%, p < 0.001) and in the patients with a recent myocardial infarction (27%, P < 0.001) and were almost completely absent in the patients with stable angina (1.5%). The high prevalence of complex coronary artery lesion morphology and of intravascular thrombi observed in patients with unstable angina or with a recent myocardial infarction emphasizes the important role of intima disruption and of subsequent thrombosis in the pathogenesis of myocardial ischemia in those unstable syndromes of ischemic heart disease.