CORRELATION OF ANGIOGRAPHIC MORPHOLOGY AND CLINICAL PRESENTATION IN UNSTABLE ANGINA

Objectives. This study sought to correlate angiographically detected c omplex lesions and intracoronary thrombus with the severity of clinica l presentation in unstable angina (UA). Background. Unstable angina is usually related to acute thrombosis superimposed on a disrupted plaqu e. Complex and thrombotic lesions are more prevalent in UA and have be en associated with a worse prognosis. The highest levels of the Braunw ald classification of UA (III = rest angina within 48 h of presentatio n; C = postinfarction angina; and c = angina refractory to maximal med ical therapy) can be used to assess the severity of clinical presentat ion, but they have not been directly correlated with thrombotic and co mplex lesions. Methods. We conducted a prospective study of 284 patien ts with UA who underwent cardiac catheterization. A single angiographe r with no knowledge of the clinical classifications interpreted all an giograms. Culprit lesions identified in 200 patients were classified a s simple or complex. Complex lesions included the categories complex m orphology, intracoronary thrombus (ICT) or total occlusion. Lesions we re also quantitatively analyzed, and Thrombolysis in Myocardial Infarc tion (TIMI) flow was assessed. Univariate and multivariate logistic re gression analyses of the angiographic findings were performed controll ing for all cardiac risk factors, previous angioplasty or bypass surge ry and multivessel disease, and we sequentially compared Braunwald cla sses III, C and c with classes <III, <C and <c, respectively. Results. Class III was associated with complex lesions (p = 0.04) and decrease d TIMI flow (p = 0.03). Class C angina correlated with complex lesions (p = 0.04), ICT (p = 0.005) and decreased TIMI flow (p = 0.03). Class c angina was associated with ICT (p = 0.02). The degree of stenosis b y quantitative angiography was not associated with any particular Brau nwald class. Conclusions. Recent rest pain and refractory or postinfar ction UA, or both, are strongly associated with the general category o f complex lesions and specifically with angiographically detected ICT and decreased TIMI flow. (C) 1997 by the American College of Cardiolog y.