Frequency of low-grade residual coronary stenosis after thrombolysis during acute myocardial infarction

James C. Marshall, Harvey L. Waxman, Anthony Sauerwein, Ian Gilchrist, Peter B. Kurnik

Research output: Contribution to journalArticle

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Abstract

The clinical, angiographic and demographic characteristics of 42 patients with low-grade (<50%) residual stenosis at the infarct lesion after thrombolysis for acute myocardial infarction (MI) were assessed. The study group (group I) represented 21% of 198 consecutive patients receiving thrombolytic therapy over a 59-month period. Data on the 156 remaining patients were pooled for comparison (group II). Group I patients were predominantly men (86%) who were cigarette smokers (81%). Group II patients were predominantly men (75%, p > 0.10) but were significantly older (52 ± 12 vs 56 ± 10 years, p = 0.02). Prior acute MI or angina was unusual in group I. Sixty percent had no significant (>50%) residual coronary artery disease while 25% had residual single artery disease. Average significant (>50% diameter stenosis) residual vessel disease was 0.6 ± 1.0 for group I and 1.9 ± 0.9 for group II (p < 0.001). In group I, average residual infarct lesion diameter stenosis was 36 ± 7% in the right anterior oblique and 34 ± 8% in the left anterior oblique views. Thirty-nine group I patients were discharged with medical therapy and 100% follow-up was obtained over a mean interval of 18 ± 17 months. Fifteen patients experienced chest pain after acute MI accounting for 17 discrete events. Fifty-nine percent of group I had a benign course on follow-up. Eight events were classified as unstable angina, 4 as acute MI and 5 as atypical angina. Documented coronary vasospasm occurred in 3. The infarct narrowing accounted for 58% of documented ischemia and 41% of symptomatic events. Antiplatelet agents, warfarin and residual lesion morphology did not clearly influence frequency of events, whereas data regarding cigarette smoking were suggestive (p = 0.06). Events clearly associated with the infarct narrowing occurred earlier (4 ± 4 months) than events not related to (23 ± 15 months, p < 0.01). Ischemic events unrelated to the infarct lesion were often related to progressive stenosis or occlusion at the site of previously nonsignificant disease.

Original languageEnglish (US)
Pages (from-to)773-778
Number of pages6
JournalThe American journal of cardiology
Volume66
Issue number10
DOIs
StatePublished - Oct 1 1990

Fingerprint

Coronary Stenosis
Pathologic Constriction
Myocardial Infarction
Coronary Vasospasm
Platelet Aggregation Inhibitors
Unstable Angina
Warfarin
Chest Pain
Coronary Artery Disease
Ischemia
Arteries
Smoking
Demography
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Marshall, James C. ; Waxman, Harvey L. ; Sauerwein, Anthony ; Gilchrist, Ian ; Kurnik, Peter B. / Frequency of low-grade residual coronary stenosis after thrombolysis during acute myocardial infarction. In: The American journal of cardiology. 1990 ; Vol. 66, No. 10. pp. 773-778.
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title = "Frequency of low-grade residual coronary stenosis after thrombolysis during acute myocardial infarction",
abstract = "The clinical, angiographic and demographic characteristics of 42 patients with low-grade (<50{\%}) residual stenosis at the infarct lesion after thrombolysis for acute myocardial infarction (MI) were assessed. The study group (group I) represented 21{\%} of 198 consecutive patients receiving thrombolytic therapy over a 59-month period. Data on the 156 remaining patients were pooled for comparison (group II). Group I patients were predominantly men (86{\%}) who were cigarette smokers (81{\%}). Group II patients were predominantly men (75{\%}, p > 0.10) but were significantly older (52 ± 12 vs 56 ± 10 years, p = 0.02). Prior acute MI or angina was unusual in group I. Sixty percent had no significant (>50{\%}) residual coronary artery disease while 25{\%} had residual single artery disease. Average significant (>50{\%} diameter stenosis) residual vessel disease was 0.6 ± 1.0 for group I and 1.9 ± 0.9 for group II (p < 0.001). In group I, average residual infarct lesion diameter stenosis was 36 ± 7{\%} in the right anterior oblique and 34 ± 8{\%} in the left anterior oblique views. Thirty-nine group I patients were discharged with medical therapy and 100{\%} follow-up was obtained over a mean interval of 18 ± 17 months. Fifteen patients experienced chest pain after acute MI accounting for 17 discrete events. Fifty-nine percent of group I had a benign course on follow-up. Eight events were classified as unstable angina, 4 as acute MI and 5 as atypical angina. Documented coronary vasospasm occurred in 3. The infarct narrowing accounted for 58{\%} of documented ischemia and 41{\%} of symptomatic events. Antiplatelet agents, warfarin and residual lesion morphology did not clearly influence frequency of events, whereas data regarding cigarette smoking were suggestive (p = 0.06). Events clearly associated with the infarct narrowing occurred earlier (4 ± 4 months) than events not related to (23 ± 15 months, p < 0.01). Ischemic events unrelated to the infarct lesion were often related to progressive stenosis or occlusion at the site of previously nonsignificant disease.",
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Frequency of low-grade residual coronary stenosis after thrombolysis during acute myocardial infarction. / Marshall, James C.; Waxman, Harvey L.; Sauerwein, Anthony; Gilchrist, Ian; Kurnik, Peter B.

In: The American journal of cardiology, Vol. 66, No. 10, 01.10.1990, p. 773-778.

Research output: Contribution to journalArticle

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AU - Marshall, James C.

AU - Waxman, Harvey L.

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N2 - The clinical, angiographic and demographic characteristics of 42 patients with low-grade (<50%) residual stenosis at the infarct lesion after thrombolysis for acute myocardial infarction (MI) were assessed. The study group (group I) represented 21% of 198 consecutive patients receiving thrombolytic therapy over a 59-month period. Data on the 156 remaining patients were pooled for comparison (group II). Group I patients were predominantly men (86%) who were cigarette smokers (81%). Group II patients were predominantly men (75%, p > 0.10) but were significantly older (52 ± 12 vs 56 ± 10 years, p = 0.02). Prior acute MI or angina was unusual in group I. Sixty percent had no significant (>50%) residual coronary artery disease while 25% had residual single artery disease. Average significant (>50% diameter stenosis) residual vessel disease was 0.6 ± 1.0 for group I and 1.9 ± 0.9 for group II (p < 0.001). In group I, average residual infarct lesion diameter stenosis was 36 ± 7% in the right anterior oblique and 34 ± 8% in the left anterior oblique views. Thirty-nine group I patients were discharged with medical therapy and 100% follow-up was obtained over a mean interval of 18 ± 17 months. Fifteen patients experienced chest pain after acute MI accounting for 17 discrete events. Fifty-nine percent of group I had a benign course on follow-up. Eight events were classified as unstable angina, 4 as acute MI and 5 as atypical angina. Documented coronary vasospasm occurred in 3. The infarct narrowing accounted for 58% of documented ischemia and 41% of symptomatic events. Antiplatelet agents, warfarin and residual lesion morphology did not clearly influence frequency of events, whereas data regarding cigarette smoking were suggestive (p = 0.06). Events clearly associated with the infarct narrowing occurred earlier (4 ± 4 months) than events not related to (23 ± 15 months, p < 0.01). Ischemic events unrelated to the infarct lesion were often related to progressive stenosis or occlusion at the site of previously nonsignificant disease.

AB - The clinical, angiographic and demographic characteristics of 42 patients with low-grade (<50%) residual stenosis at the infarct lesion after thrombolysis for acute myocardial infarction (MI) were assessed. The study group (group I) represented 21% of 198 consecutive patients receiving thrombolytic therapy over a 59-month period. Data on the 156 remaining patients were pooled for comparison (group II). Group I patients were predominantly men (86%) who were cigarette smokers (81%). Group II patients were predominantly men (75%, p > 0.10) but were significantly older (52 ± 12 vs 56 ± 10 years, p = 0.02). Prior acute MI or angina was unusual in group I. Sixty percent had no significant (>50%) residual coronary artery disease while 25% had residual single artery disease. Average significant (>50% diameter stenosis) residual vessel disease was 0.6 ± 1.0 for group I and 1.9 ± 0.9 for group II (p < 0.001). In group I, average residual infarct lesion diameter stenosis was 36 ± 7% in the right anterior oblique and 34 ± 8% in the left anterior oblique views. Thirty-nine group I patients were discharged with medical therapy and 100% follow-up was obtained over a mean interval of 18 ± 17 months. Fifteen patients experienced chest pain after acute MI accounting for 17 discrete events. Fifty-nine percent of group I had a benign course on follow-up. Eight events were classified as unstable angina, 4 as acute MI and 5 as atypical angina. Documented coronary vasospasm occurred in 3. The infarct narrowing accounted for 58% of documented ischemia and 41% of symptomatic events. Antiplatelet agents, warfarin and residual lesion morphology did not clearly influence frequency of events, whereas data regarding cigarette smoking were suggestive (p = 0.06). Events clearly associated with the infarct narrowing occurred earlier (4 ± 4 months) than events not related to (23 ± 15 months, p < 0.01). Ischemic events unrelated to the infarct lesion were often related to progressive stenosis or occlusion at the site of previously nonsignificant disease.

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