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Coronary angiographic findings in acute myocardial infarction Angiographic studies performed in the earliest hours of acute myocardial infarction in patients presenting with ST-segment elevation have revealed approximately a 90%incidence of total occlusion of the infarct-related vessel (1). Recanalization from spontaneousthrombolysisas well as attribution due to some mortality amongthose patients with total occlusion results in a diminishing incidence of angiographically totally occluded vessels in the period following myocardial infarction. In contrast to patients with a Q-wave infarction, those patients who sustain a non-Q-wave infarction have a much lower incidence (30%) of complete occlusion of the infarct-related coronary artery. Intracoronary infusion of streptokinase was reported as successful therapy for acute myocardial infarction (2). Soon after that, the commonmorphologic feature, probably representing a disrupted atherosclerotic plaque, on angiogramin acute myocardial infarction after coronary thrombolysis was found. In manyseries of patients studied in the early and subacute phase by serial coronary angiograms, 5-10% of patients with acute myocardial infarction are found to have mild stenotic vessels in the subacute phase. In these patients, thrombus that has lysed and the transient occlusive platelet aggregate may have been responsible for occlusion. These clinical data suggest that angiographically complex lesions with thrombosis are frequent in the pathogenesis of myocardial infarction.

Development of Acute Coronary Syndrome and Progression of Coronary Artery Disease. A Serial Clinical-angiographic Analysis.