Computed tomographic angiography for localizing the site of plaque disruption/thrombus: is detection so complex?

In the 1980s, our group published a series of articles using invasive angiography (ICA) to investigate the pathogenesis of unstable angina and acute myocardial infarction.1–5 In individuals in whom an angina-producing lesion could be assessed angiographically and the vessel was 100% occluded at the time of angiography, the qualitative morphology of these lesions was different from that of lesions associated with stable angina.1 Unstable angina was precisely defined as either the acute onset of rest pain or crescendo angina with an abrupt increase in duration and/or frequency in angina pectoris. Myocardial infarction was defined according to the terminology of the day as either subendocardial or transmural myocardial infarction.