Prevalence of Total Coronary Occlusion during the Early Hours of Transmural Myocardial Infarction

TLDR

The study aimed to determine the prevalence of total coronary occlusion within the first 24 hours after transmural myocardial infarction by performing coronary arteriography on 322 patients. Coronary arteriography was used to evaluate the degree of coronary obstruction in these patients. Total coronary occlusion was present in 87 % of patients examined within four hours of symptom onset, decreasing to 65 % between 12–24 hours; thrombus was successfully retrieved in 88 % of thrombosis cases, while 25 % of non‑thrombosis patients had a false‑negative thrombus finding, indicating early occlusion that resolves over the first day.

Abstract

To define the prevalence of total coronary occlusion in the hours after transmural myocardial infarction, we used coronary arteriography to study the degree of coronary obstruction in 322 patients admitted within 24 hours of infarction. Total coronary occlusion was observed in 110 of 126 patients (87 per cent) who were evaluated within four hours of the onset of symptoms; this proportion decreased significantly, to 37 of 57 (65 per cent), when patients were studied 12 to 24 hours after the onset of symptoms. Among 59 patients with angiographic features of coronary thrombosis, the thrombus was retrieved by Fogarty catheter in 52 (88 per cent) but was absent in seven (12 per cent false positive). Among an additional 20 patients without angiographic features of thrombosis, a thrombus was discovered in five (25 per cent false negative). Thus, total coronary occlusion is frequent during the early hours of transmural infarction and decreases in frequency during the initial 24 hours, suggesting that coronary spasm or thrombus formation with subsequent recanalization or both may be important in the evolution of infarction.