Angiographic Morphology in Patients with Unstable Angina Pectoris

Complex morphology and intracoronary thrombus occur frequently in patients with unstable angina pectoris, but their relation to the time of symptomatic presentation, timing of angiography and inhospital cardiac events has not been investigated. Acoordingly, in 112 consecutive patients with unstable angina pectoris, we performed coronary angiography either in the first day of hospital admission (16±6 hours, n=44) or later in the post-admission days (4.6±1.8 days, n=68). Significant coronary artery disease was defined as any ?% 50 stenosis, and complex morphology as any stenosis with irregularity or overhang. Coronary thrombi were present in 57% (25/44) of early angiography patients (p<0.001). Complex coronary morphology occurred in 55% (22/44) of early angiography patients and 47% (32/68) of Iate angiography patients 47% (p<0.001). Cardiac events (death, myocardial infarction, and urgent revascularization) occurred in 78 % (36/46) of patients with coronary thrombus, in 53 % (29/55) of the patients with complex morphology, and in 48% (42/87) of the patients with multiplevessel disease. On the other hand, the occurrence rates of cardiac events in the patients without these angiographic features were 17% (9/66) (p<0.001), 26% (15/57) (p<0.01), 12% (3/25) (p<0.001), respectively. This study showed that the presence of intracoronary thrombus was associated with a higher incidence of in-hospital cardiac events. Also angiographic detection of intracoronary thrombi varies according to the temporal relation between angiography and chest pain at rest.