Clinical and Prognostic Significance of Multifocal Atherosclerosis in Patients With Acute Coronary Syndromes Without ST-segment Elevation

Aim of the study was to determine incidence of multifocal atherosclerosis (MFA), to assess its clinical and prognostic significance in the hospital phase in patients with non-ST elevation acute coronary syndrome (NSTEACS). We studied data from 225 patients with duration of NSTEACS 48 hours or less, who along with usual examination were subjected to coronary angiography and color duplex scanning of extracranial arteries and arteries of lower extremities. As lesions we considered any stenosis irrespective of intima media thickness. MFA was detected in 43.6% of cases. Patients with MFA were older, they more often had history of myocardial infarction, had lower creatinine clearance, and left ventricular ejection fraction. Presence of artery stenoses in 3 vascular regions was associated with multivessel coronary artery disease. Inhospital "endpoints" (myocardial infarction, stroke, death) occurred more frequently in patients with MFA. Patients with lesions in 2 and 3 vascular beds were characterized by maximal Grace score, while those without coronary and peripheral artery involvement - by minimal Grace score. The presence of MFA in patients with NSTEACS was associated with unfavourable course of the disease. Thus ptatients with MFA were characterized by high average rating on Grace scale; involvement of three vascular beds was associated with high mortality.