AHC/ACC Stenosis Morphology Classification Based Comparison of Coronary Angiographic Lesions in Patients with Acute Coronary Syndrome (ACS) and Chronic Stable Angina (CSA) in a Tertiary Care Centre

Aim The study was designed to compare the coronary angiographic lesions in patients with acute coronary syndrome (ACS) and chronic stable angina (CSA) based on the American Heart Association/American College of Cardiology (AHC/ACC) stenosis morphology classification in a tertiary care center in Bangladesh. Methods We studied 215 angiographic lesions in 110 patients, including 55patients with ACS and 55 with CSA, who had coronary angiogram in the University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. Results Mean age of the study subjects was 52.210 years and 09 (11 %) of them were female.2 (4 %) of ACS and 6 (11 %) of CSA patients had normal coronary angiogram. Frequency of SVD was significantly higher (p less than0.001) in patients with ACS. CSA patients had significantly higher (pless than0.001) TVD with more common involvement of LM, RCA and LCX than in ACS patients. A total of 215 coronary lesions in rest 102 subjects was detected, 83 (39 %) in ACS and 132 (61 %) in CSA. Frequency of type A, type B and type C in ACS and CSA was 13 %, 65 %, 22 % and 10 %, 62 %, 23 %, respectively with significantly more prevalence of simple (A+B1) lesions in CSA (59 % versus 22 %) and the complex (B2+C) lesions in ACS (78 % versus 41 %) patients (p 0.000). The discrete, eccentric and lesion irregularity were significantly more in ACS than in CSA. On the contrary, the tubular, concentric and smooth lesions were significantly more in CSA than in ACS. Intracoronary thrombus were detected in ACS only (11 %), none in CSA (p less than0.001). Diffuse lesion, ostial location, moderate tortuosity, moderate angulation, calcification, total occlusion, excessive tortuosity and extremely angulation were more in CSA than in ACS with no statistical significant differences. Conclusion Observed differences in coronary angiogram findings between the study subsets in this study based on AHC/ACC stenosis morphology classification will yield ischemic heart disease patients better and cost-effective management including PCI or CABG.