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(Circulation. 2000;102:2063.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Considerable Time From the Onset of Plaque Rupture and/or Thrombi Until the Onset of Acute Myocardial Infarction in Humans
Coronary Angiographic Findings Within 1 Week Before the Onset of Infarction
From MUGIC Group: Multicenter Study in Gifu University and Affiliated Hospitals (Gifu University School of Medicine [H.T., M.K., K.N., G.T., T.N., S.M., H.F.], Gifu Municipal Hospital [S.O., T.T., K.U.], Gifu Prefectural Hospital [T.M., S.W.], Matsunami General Hospital [N.M.], National Gifu Hospital [T.N., I.N.], and Tosei General Hospital [K.S.], Gifu, Japan; and National Toyohasi-Higashi Hospital [K.Y., T.S.], Aichi, Japan) on Cardiac Group, Japan.
Correspondence to Hisayoshi Fujiwara, MD, The Second Department of Internal Medicine, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu, 500, Japan. E-mail gifuim-gif{at}umin.ac.jp
Background—It has been thought that the thrombi and bleeding in plaques that occur after plaque rupture or endothelial damage from vessels with mild stenosis suddenly occlude the lumen and cause acute myocardial infarction (AMI). However, our hypothesis is that thrombi and bleeding may not suddenly occlude the lumen.
Methods and Results—The study group consisted of 20 patients who had coronary angiograms performed within 1 week (3±3 days) before AMI and 20 control patients who had coronary angiograms performed 6 to 18 months (282±49 days) before AMI. The features of infarct-related coronary segments (IRCS) at 3 days before AMI were the presence of a significant stenosis of >50% (95% in incidence and 71±12% diameter stenosis) and Ambrose’s type II eccentric lesions (plus multiple irregularities), an indicator of plaque rupture and/or thrombi (60% [70%]), and the features at 1 year before AMI were mild stenosis of <50% (95% incidence and 30±18% diameter stenosis) with rare Ambrose’s type II eccentric lesions (plus multiple irregularities) (10% [10%]). The same relation was observed in each of the 4 subgroups with Q-wave infarction, non–Q-wave infarction, preceding effort angina within 1 month before AMI, and no preceding effort angina.
Conclusions—The appearance of marked progression and Ambrose’s type II eccentric lesion on coronary angiograms 3 days before AMI suggests the presence of a considerable time from the onset of plaque rupture and/or thrombi until the onset of AMI. These features may be predictors of AMI. The concept provides new insight into the mechanism and prevention of human AMIs.
Key Words: angiography • myocardial infarction • coronary disease • plaque
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