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Circulation, Vol 77, 526-534, Copyright © 1988 by American Heart Association
K Gotoh, T Minamino, O Katoh, Y Hamano, S Fukui, M Hori, H Kusuoka, M Mishima, M Inoue and T Kamada
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)
ARTICLES
The role of intracoronary thrombus in unstable angina: angiographic assessment and thrombolytic therapy during ongoing anginal attacks
First Department of Medicine, Osaka University Medical School, Japan.
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