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Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?
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1988
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Subsequent Myocardial InfarctionCoronary Artery DiseaseAcute Myocardial InfarctionStrokePublic HealthAtherosclerosisCardiologyCardiac ImagingRadiologyMyocardial InfarctionCardiovascular ImagingSevere StenosisCoronary StenosisEpidemiologyCoronary Heart DiseaseCardiovascular DiseaseCoronary UnitMedicineEmergency Medicine
The study aimed to determine whether coronary angiography can predict the site of a future myocardial infarction by evaluating angiograms of 42 consecutive patients before and after an acute MI. The authors reviewed pre‑ and post‑MI coronary angiograms of these patients to assess predictive value. Of the 42 patients, 29 experienced new coronary occlusions; most occluded arteries were not the most severely stenosed initially, and there was no correlation between initial stenosis severity and infarction timing, indicating that angiographic stenosis severity alone is insufficient to predict future MI site or timing.
To help determine if coronary angiography can predict the site of a future coronary occlusion that will produce a myocardial infarction, the coronary angiograms of 42 consecutive patients who had undergone coronary angiography both before and up to a month after suffering an acute myocardial infarction were evaluated. Twenty-nine patients had a newly occluded coronary artery. Twenty-five of these 29 patients had at least one artery with a greater than 50% stenosis on the initial angiogram. However, in 19 of 29 (66%) patients, the artery that subsequently occluded had less than a 50% stenosis on the first angiogram, and in 28 of 29 (97%), the stenosis was less than 70%. In every patient, at least some irregularity of the coronary wall was present on the first angiogram at the site of the subsequent coronary obstruction. In only 10 of the 29 (34%) did the infarction occur due to occlusion of the artery that previously contained the most severe stenosis. Furthermore, no correlation existed between the severity of the initial coronary stenosis and the time from the first catheterization until the infarction (r2 = 0.0005, p = NS). These data suggest that assessment of the angiographic severity of coronary stenosis may be inadequate to accurately predict the time or location of a subsequent coronary occlusion that will produce a myocardial infarction.