[Coronary arteriography and coronary angioplasty in stable ischemic heart disease. Value in the prediction and prevention of future acute myocardial infarction].

Acute myocardial infarction (AMI) is usually caused by the sudden formation of an intracoronary thrombus that occludes the coronary artery at the site of a vulnerable atherosclerotic plaque. Coronary angiography (KAG) offers the opportunity to visualize and characterize coronary artery lesions. The demonstration of significant stenoses (> 50%) often leads to mechanical revascularization, including coronary angioplasty (PTCA). Several studies in which serial angiograms were performed on patients who subsequently had AMI have shown that most of these acute events develop from lesions that on the first KAG were nonsignificant (< 50%). The KAG method does not adequately predict the location of the culprit plaque that will subsequently produce AMI PTCA results in less severe angina, but the price may be a higher rate of procedure related acute events. Large scale trials comparing the prognostic effect of an intense medical therapy versus PTCA with and without stenting are required to better define the independent and combined roles of the different therapeutic modalities in stable ischaemic heart disease.