Angiographic Evaluation of Culprit Lesions in Acute Coronary Syndrome : Relation to the Original Site on Previous Coronary Angiography

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Culprit lesions in acute coronary syndrome[acute myocardial infarction(AMI)and unstable angina pectoris(UAP)]were examined angiographically in 222 patients who had previously undergone coronary angiography(CAG).The observation period lasted 5 years after primary CAG in medically treated patients(group M, 127 cases)and after final folloe-up CAG in patients treated by percutaneous transluminal coronary angioplasty(PTCA)(group B, 95 cases).There were 33 AMIs, including 5 deaths(22/127, 17.3%, in group M vs 11/95, 11.6%, in group B;p<0.01)and 189 UAPs(105/127, 82.7%, in group M vs 84/95, 88.4%, in group B;NS).High-grade stenoses(>75%)were found in 76(59.8%)patients in group M, of which 41 lesions(54%)resulted in acute coronary syndromes(ACSs).In group M, ACSs resulted from insignificant stenosisd(≨50%)in 67(53%)patients and from significant stenosis(>50%)in 60(47%)patients.In group B, ACSs resulted from insignificant stenosis in 78(82%)patients and from significant stenosis in 17(18%)patients.Out of 95 PTCA sites, high-grade restenosis occurred in 3 lesions and ACSs(2 AMI, 14 UAP)in 16(16.8%).We conclude that ACSs are more likely to develop from insignificant lesions that from significant lesions.Highgrade stenoses are prone to become occlusive lesions and PTCA reduces this potential risk.Most target sites of PTCA that escaped restenosis were stable in the long term.
社団法人日本循環器学会の論文
1998-04-20