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. 1980 May;43(5):493–498. doi: 10.1136/hrt.43.5.493

Myocardial infarction with normal coronary angiogram. Possible mechanism of smoking risk in coronary artery disease.

W J McKenna, C Y Chew, C M Oakley
PMCID: PMC482331  PMID: 7378207

Abstract

The coronary angiograms of 120 consecutive patients under 40 years of age were examined. Ten new cases of myocardial infarction with normal coronary arteriogram were identified (group 1) and compared with 30 cases of myocardial infarction and obstructive coronary disease (group 2). Heavy cigarette smoking was the sole major risk factor in group 1. Patients in group 2 smoked as well but most also had hypercholesterolaemia or hypertension. Pre- and postinfarction angina was rare among the patients with myocardial infarction and normal coronary arteriogram, and recanalisation after smoking-induced thrombotic occlusion is thought to be the most likely mechanism. Smoking-induced thrombosis is only likely to be recognised in special circumstances, when it develops in apparently normal coronary arteries, is followed by recanalisation, and is complicated by infarction as a permanent marker of previous obstruction to regional myocardial blood flow. Thrombotic occlusion of a "normal" coronary artery without recanalisation will only be recognised when infarction is fatal. If smoking can predispose to thrombosis in "normal" coronary arteries, it may be even more likely to accelerate thrombosis in atheromatous coronary arteries. The importance of recognising group 1 may well be in relation to the much commoner group 2.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Auerbach O., Hammond E. C., Garfinkel L. Smoking in relation to atherosclerosis of the coronary arteries. N Engl J Med. 1965 Oct 7;273(15):775–779. doi: 10.1056/NEJM196510072731501. [DOI] [PubMed] [Google Scholar]
  2. Auerbach O., Hammond E. C., Garfinkel L. Thickening of walls of arterioles and small arteries in relation to age and smoking habits. N Engl J Med. 1968 May 2;278(18):980–984. doi: 10.1056/NEJM196805022781803. [DOI] [PubMed] [Google Scholar]
  3. Ball K., Turner R. Smoking and the heart. The basis for action. Lancet. 1974 Oct 5;2(7884):822–826. doi: 10.1016/s0140-6736(74)91083-6. [DOI] [PubMed] [Google Scholar]
  4. Eliot R. S., Baroldi G., Leone A. Necropsy studies in myocardial infarction with minimal or no coronary luminal reduction due to atherosclerosis. Circulation. 1974 Jun;49(6):1127–1131. doi: 10.1161/01.cir.49.6.1127. [DOI] [PubMed] [Google Scholar]
  5. Gordon T., Kannel W. B., McGee D., Dawber T. R. Death and coronary attacks in men after giving up cigarette smoking. A report from the Framingham study. Lancet. 1974 Dec 7;2(7893):1345–1348. doi: 10.1016/s0140-6736(74)92214-4. [DOI] [PubMed] [Google Scholar]
  6. Henderson R. R., Hansing C. E., Razavi M., Rowe G. G. Resolution of an obstructive coronary lesion as demonstrated by selective angiography in a patient with transmural myocardial infarction. Am J Cardiol. 1973 Jun;31(6):785–788. doi: 10.1016/0002-9149(73)90016-7. [DOI] [PubMed] [Google Scholar]
  7. Johnson A. D., Detwiler J. H. Coronary spasm, variant angina, and recurrent myocardial infarctions. Circulation. 1977 Jun;55(6):947–950. doi: 10.1161/01.cir.55.6.947. [DOI] [PubMed] [Google Scholar]
  8. Khan A. H., Haywood L. J. Myocardial infarction in nine patients with radiologically patent coronary arteries. N Engl J Med. 1974 Aug 29;291(9):427–431. doi: 10.1056/NEJM197408292910901. [DOI] [PubMed] [Google Scholar]
  9. Oliva P. B., Breckinridge J. C. Acute myocardial infarction with normal and near normal coronary arteries. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). Am J Cardiol. 1977 Dec;40(6):1000–1007. doi: 10.1016/0002-9149(77)90052-2. [DOI] [PubMed] [Google Scholar]
  10. Rosenblatt A., Selzer A. The nature and clinical features of myocardial infarction with normal coronary arteriogram. Circulation. 1977 Apr;55(4):578–580. doi: 10.1161/01.cir.55.4.578. [DOI] [PubMed] [Google Scholar]
  11. Selzer A., Langston M., Ruggeroli C., Cohn K. Clinical syndrome of variant angina with normal coronary arteriogram. N Engl J Med. 1976 Dec 9;295(24):1343–1347. doi: 10.1056/NEJM197612092952403. [DOI] [PubMed] [Google Scholar]
  12. Wilhelmsson C., Vedin J. A., Elmfeldt D., Tibblin G., Wilhelmsen L. Smoking and myocardial infarction. Lancet. 1975 Feb 22;1(7904):415–420. doi: 10.1016/s0140-6736(75)91488-9. [DOI] [PubMed] [Google Scholar]

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