This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gotoh, K. Articles by Kamada, T. Search for Related Content PubMed PubMed Citation Articles by Gotoh, K. Articles by Kamada, T.

Circulation, Vol 77, 526-534, Copyright © 1988 by American Heart Association

ARTICLES

The role of intracoronary thrombus in unstable angina: angiographic assessment and thrombolytic therapy during ongoing anginal attacks

K Gotoh, T Minamino, O Katoh, Y Hamano, S Fukui, M Hori, H Kusuoka, M Mishima, M Inoue and T Kamada
First Department of Medicine, Osaka University Medical School, Japan.

Intracoronary thrombus is regarded as a potentially important factor in the etiology of unstable angina, but the incidence of intracoronary thrombus in unstable angina has not been clearly defined. To determine the occurrence of intracoronary thrombus during ongoing angina pectoris, coronary angiography was performed during spontaneous ischemic attacks in 37 patients with prolonged rest angina. All patients exhibited significant (greater than 50%) stenoses of at least one major coronary artery. Of the 37 patients, 21 (57%) had intracoronary thrombus in major coronary arteries, whereas 14 (38%) had fixed narrowings without evidence of intracoronary thrombus and two exhibited coronary spasm. ST segment elevation was observed in 16 of 21 patients with thrombus and in all of the patients with coronary spasm, but all the patients with organic stable obstruction showed ST segment depression. Twenty of the 21 patients with thrombus improved after thrombolytic therapy with intracoronary injection of urokinase; obstructed arteries were reopened, or narrowings were attenuated, with relief of ischemic symptoms. In patients with fixed obstructions, the rate-pressure product during active symptoms was significantly higher than during an asymptomatic period, indicating that a transient increase in myocardial oxygen demand may contribute to the ischemic attack in these patients. A high incidence (71%) of recurrent symptoms was observed in patients with intracoronary thrombus even after successful thrombolysis, in contrast to a much lower incidence (36%) in those without intracoronary thrombus. Myocardial infarction within 4 weeks after catheterization was observed more frequently in patients with intracoronary thrombus (24%) than in those without thrombus (7%).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				D. J. Duncker and R. J. Bache Regulation of Coronary Blood Flow During Exercise Physiol Rev, July 1, 2008; 88(3): 1009 - 1086. [Abstract] [Full Text] [PDF]

				J. Figueras, Y. Monasterio, R. M. Lidon, E. Nieto, and J. Soler-Soler Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2036 - 2043. [Abstract] [Full Text] [PDF]

				Y.-H. Li, J.-K. Teng, W.-C. Tsai, L.-M. Tsai, L.-J. Lin, H.-R. Guo, and J.-H. Chen Prognostic significance of elevated hemostatic markers in patients with acute myocardial infarction J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1543 - 1548. [Abstract] [Full Text] [PDF]

				J M Mann, J C Kaski, W I Pereira, S Arie, J A Ramires, and F Pileggi Histological patterns of atherosclerotic plaques in unstable angina patients vary according to clinical presentation Heart, July 1, 1998; 80(1): 19 - 22. [Abstract] [Full Text]

				M. Owa, H. Origasa, M. Saito, and M. Owa Predictive Validity of the Braunwald Classification of Unstable Angina for Angiographic Findings, Short-Term Prognoses, and Treatment Selection Angiology, August 1, 1997; 48(8): 663 - 671. [Abstract] [PDF]

				J. A. Bittl, J. Strony, J. A. Brinker, W. H. Ahmed, C. R. Meckel, B. R. Chaitman, J. Maraganore, E. Deutsch, B. Adelman, and The Hirulog Angioplasty Study Investigators Treatment with Bivalirudin (Hirulog) as Compared with Heparin during Coronary Angioplasty for Unstable or Postinfarction Angina N. Engl. J. Med., September 21, 1995; 333(12): 764 - 769. [Abstract] [Full Text] [PDF]

				H. M. Hoffmeister, M. Jur, H. P. Wendel, W. Heller, and L. Seipel Alterations of Coagulation and Fibrinolytic and Kallikrein-Kinin Systems in the Acute and Postacute Phases in Patients With Unstable Angina Pectoris Circulation, May 15, 1995; 91(10): 2520 - 2527. [Abstract] [Full Text]

				J. F. Mitchel, D. B. Fram, D. F. Palme II, R. Foster, J. A. Hirst, M. A. Azrin, L. M. Bow, A. M. Eldin, D. D. Waters, and R. G. McKay Enhanced Intracoronary Thrombolysis With Urokinase Using a Novel, Local Drug Delivery System : In Vitro, In Vivo, and Clinical Studies Circulation, February 1, 1995; 91(3): 785 - 793. [Abstract] [Full Text]

				K. Mizuno, A. Miyamoto, K. Isojima, A. Kurita, A. Senoo, T. Arai, M. Kikuchi, and H. Nakamura A Serial Observation of Coronary Thrombi in Vivo by a New Percutaneous Transluminal Coronary Angioscope Angiology, February 1, 1992; 43(2): 91 - 99. [Abstract] [PDF]

				D. W. M. Muller and E. J. Topol Selection of Patients with Acute Myocardial Infarction for Thrombolytic Therapy Ann Intern Med, December 15, 1990; 113(12): 949 - 960. [Abstract] [PDF]

				T. H. Lee, M. C. Weisberg, D. A. Brand, G. W. Rouan, and L. Goldman Candidates for Thrombolysis among Emergency Room Patients with Acute Chest Pain: Potential True- and False-Positive Rates Ann Intern Med, June 15, 1989; 110(12): 957 - 962. [Abstract] [PDF]

				INTRACORONARY THROMBOSIS IMPORTANT IN UNSTABLE ANGINA Journal Watch (General), March 18, 1988; 1988(318): 3 - 3. [Full Text]