Despite a growing awareness of the correlation of
coronary artery stenoses morphology with clinical syndromes, no comprehensive, prospective analysis of the implications of
stenosis morphology on risk of
myocardial infarction has been reported. Angiograms from 118 patients, representative of the 4.9% of medically treated Coronary Artery Surgery Study (
CASS) patients who during subsequent 3 year follow-up study had an anterior
myocardial infarction, were matched on the basis of arteriographic anatomy and disease with 141 patients who did not have an anterior
infarction. Angiograms from these 259 patients with 557 left anterior descending artery
stenoses were reviewed without knowledge of clinical outcome. Conditional regression analyses were performed to determine the importance of
stenosis morphology, relative to computer-determined
stenosis severity and other clinical variables, in the prediction of risk of
infarction. Univariate analysis revealed
luminal roughness (odds ratio 4.5; p = 0.001) and lesion length (odds ratio 1.7 per unit length; p = 0.007) to be highly correlated with future risk of
infarction. Multivariate analysis revealed left anterior descending artery percent
stenosis greater than or equal to 50%, lesion roughness, left circumflex artery
stenosis and smoking, in that order, to be predictive of anterior
myocardial infarction, whereas 22 other morphologic variables were not independently predictive of outcome. The importance of
stenosis roughness may relate to its propensity for thrombogenesis and should be considered in clinical decision making.