NEW YORK (Reuters Health), Jun 3 - Although myocardial infarction has been generally thought to be associated with coronary stenoses with a diameter reduction of less than 50%, this may not be the case, Belgian researchers report in the May issue of the American Journal of Cardiology.
"In contrast to what is commonly believed," senior investigator Dr. Bernard De Bruyne told Reuters Health, "we have good reasons to suppose that the majority of acute coronary syndromes occur at the site of moderate-to-severe stenosis."
In a prospective study, Dr. De Bruyne and colleagues at the Cardiovascular Center Aalst found that the average diameter of stenosis in the culprit lesion was similar in 102 patients with acute ST-elevation myocardial infarction (STEMI) in whom thrombus aspiration had been performed and in 80 patients with stable angina pectoris. In 135 patients with non-STEMI or unstable angina pectoris, the diameter was slightly larger.
After the thrombus was removed, the researchers found that in patients with STEMI, only 11% of the culprit lesions had a stenosis diameter of less than 50%.
The investigators pointed out that the "clinical outcome related to mild coronary stenosis appeared favorable and did not seem to justify mechanical interventions to prevent spontaneous occlusion."
These findings, Dr. De Bruyne added, "imply that looking for the true severity of the stenosis is important and that other means than the mere angiogram should be used."
By David Douglas
Am J Cardiol 2009;103:1183-1188.
Last Updated: 2009-06-02 16:25:11 -0400 (Reuters Health)
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