ANGIOSCOPIC PREDICTORS OF EARLY ADVERSE OUTCOME AFTER CORONARY ANGIOPLASTY IN PATIENTS WITH UNSTABLE ANGINA AND NON-Q-WAVE MYOCARDIAL-INFARCTION

Background Clinical and angiographic criteria have a limited ability t o predict adverse outcome in patients with unstable angina who are und ergoing percutaneous transluminal coronary angioplasty (PTCA). We inve stigated whether the use of angioscopy can improve prediction of early adverse outcome after PTCA. Methods and Results Angioscopic character ization of the culprit lesion was performed before PTCA in 32 patients with unstable angina and 10 with non-Q-wave infarction. Seven patient s (17%) had an adverse outcome (myocardial infarction, repeat PTCA, or need for coronary artery bypass graft surgery) within 24 hours after PTCA. Six of 18 patients with a yellow culprit lesion had an adverse o utcome compared with 1 of 24 in whom the culprit lesion was white (P=. 03). Six of 20 patients with plaque disruption suffered an adverse out come compared with 1 of 22 with nondisrupted plaques (P=.04). Six of 1 7 patients with intraluminal thrombus had an adverse outcome, whereas only 1 of 25 patients without thrombus suffered an adverse outcome (P= .01). Yellow color, disruption, and thrombus at the culprit lesion sit e were associated with an eightfold increase in risk of adverse outcom e after PTCA. The prediction of PTCA outcome based on characteristics of the plaque that were identifiable by angioscopy was superior to tha t estimated by the use of angiographic variables. Conclusions In patie nts with unstable angina and non-Q-wave infarction, angioscopic featur es of disruption, yellow color,or thrombus at the culprit lesion site can identify patients at high risk of early adverse outcome after PTCA . Angioscopy was superior to angiography for prediction of PTCA outcom e.