Correlation of Angiographic Morphology and Clinical Presentation in Unstable Angin

Objectives. This study sought to correlate angiographically detected complex lesions and intracoronary thrombus with the severity of clinical presentation in unstable angin (UA). Background. Unstable angin is usually related to acute thrombosis superimposed on disrupted plaque. Complex and thrombotic lesions are more prevalent in U and have been associated with worse prognosis. The highest levels of the Braunwald classification of U (III = rest angin within 48 h of presentation; C = postinfarction angina; and c = angin refractory to maximal medical therapy) can be used to assess the severity of clinical presentation, but they have not been directly correlated with thrombotic and complex lesions. Methods. We conducted prospective study of 284 patients with U who underwent cardiac catheterization. single angiographer with no knowledge of the clinical classifications interpreted all angiograms. Culprit lesions identified in 200 patients were classified as simple or complex. Complex lesions included the categories complex morphology, intracoronary thrombus (ICT) or total occlusion. Lesions were also quantitatively analyzed, and Thrombolysis in Myocardial Infarction (TIMI) flow was assessed. Univariate and multivariate logistic regression analyses of the angiographic findings were performed controlling for all cardiac risk factors, previous angioplasty or bypass surgery and multivessel disease, and we sequentially compared Braunwald classes III, C and c with classes