Angiographic morphology and intraluminal coronary artery thrombus in patients with angina pectoris: clinical correlations.

A prospective study was conducted in 104 consecutive patients who underwent coronary angiography for the evaluation of angina pectoris. 50 patients experienced unstable symptoms, while the rest of them were stable. Coronary lesions reducing the luminal diameter by at least 50% were compared between both groups according to localization, grade, length, type and collateralization. Eccentric irregular lesions (EIL) appeared more frequently in the unstable group of patients (27% vs 3%, P less than 0.01), while the incidence of concentric lesions was higher in stable group (45% vs 26%, P less than 0.02). There was no significant difference in localization, grade, length, or collateralization. EIL were most frequently identified as spontaneous AP producing lesions (55%, P less than 0.001) in 29 patients in the unstable group. Spontaneous angina was associated in 86% with EIL, occlusions, or filling defects--all of these lesions might contain occlusive or nonocclusive thrombi. EIL with a narrow neck appeared on angiograms earlier than EIL with a wall irregularity. We conclude that EIL is a sensitive and very specific angiographic marker of unstable AP. The morphologic details of EIL may help one to choose appropriate therapy.