Acute Myocardial Infarction (AMI) and Intermediate Coronary Syndrome (ICS)

doi:10.4236/health.2010.22020

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Vol.2, No.2, 131-136 (2010) Health

doi:10.4236/health.2010.22020

Acute Myocardial Infarction (AMI) and Intermediate

Coronary Syndrome (ICS)

E. Stoupel1,2, A. Tamoshiunas3, R. Radishauskas3, G. Bernotiene3, E. Abramson4, J.Sulkes4,

P. Israelevich5

1Division of Cardiology, Rabin Medical Center, Petah Tiqwa, Israel

2Sackler Faculty of Medicine, Tel Aviv University, Israel

3Institute of Cardiology, University of Medicine, Kaunas, Lithuania

Informatics & Epidemiology Unit Rabin Medical Center, Petah Tiqwa, Israel

5Department of Geophysics & Planetary Sciences, Tel Aviv University, Israel

Received 17 November 2009; revised 17 December 2009; accepted 21 December 2009.

ABSTRACT

In recent studies it was shown that blood co-

agulation and inflammation markers are raising

at high geomagnetic activity; acute myocardial

infarction and all his subtypes, mostly related to

atheromatous plaque disruption with higher

Cosmic Ray (Neutron) activity. The aim of this

study was to explore AMI and ICS differences by

concomitant physical conditions, accompany-

ing each of these acute coronary syndromes.

The data was a part of MONICA international

study in Kaunas, Lithuania in years 2000-2005

(72 consecutive months). 4633 patients with AMI

(2461 men) and 961 with ICS (654 men), (age up

to 65) were studied. For comparison four indices

of Solar (SA), three of Geomagnetic (GMA),

Cosmic Ray (CRA) measured by Neutron activity

imp/min. were used. Cosmophysical data were

from space science institutions in the USA and

Russia. Pearson correlation coefficients and

their probabilities were obtained.Monthly num-

ber of AMI and ICS shows different links with the

physical parameters: AMI were significantly in-

verse related to SA (r=-0.4, p=0.0021) and direct

to CRA (Neutron) activity (r=0.23, p=0.048). ICS

was not correlated with these two parameters,

but show significant links to GMA (r=0.25,

p=0.037). Gender differences were evident, men

more close related to changes in the mentioned

physical parameters.Conclusion: 1. Monthly nu-

mber of AMI and ICS is different related to fluc-

tuations of environmental physical parameters.

2. The described connections can affect differ-

ences in the pathogenesis of these forms of

Acute Coronary Insufficiency.

Keywords: Acute Myocardial Infarction;

Intermediate Coronary Syndrome; Geomagnetic;

Cosmic Ray; Neutron Activity

1. INTRODUCTION

Acute Coronary Syndrome includes many forms of acute

coronary insufficiency. Some related to clinical variants

connected to myocardial ischemia-blood supply deficit

due to, mostly, atherothrombosis, but also coronary artery

spasm, blood losses, vasculitis etc. As a result a number

of clinical manifestations of coronary insufficiency take

place: pain (Anginal pain), cardiac arrhythmia, resulting

in many cases Sudden Cardiac Death, Heart Failure etc.

These symptoms can be short, resulting in angina pectoris

attacks (AP), and longer and more severe, but remaining

without significant myocardial damage named Interme-

diate Coronary Syndrome (ICS) The drop of blood supply

and provoked oxygen and other vital agents disballance

for a longer time (mostly more than 20 minutes) often

lead to necrobiosis in the area of the damaged (culprit)

artery with a specific additional complex of symp-

toms:(clinical, electrocardiographic, enzymatic) and re-

sult in later scar formation, or myocardial rupture, life

threatening arrhythmias, aneurysm formation, heart fail-

ure that is considered as Acute myocardial Infarction

(AMI).The ICS takes place between AP and AMI. Recent

studied demonstrated significant links between a number

of pathogenetic factors involved in ACS development

and environmental physical activity [1-9]. The aim of this

study was to explore AMI and ICS (code I21-I22 versus

I20, ICD 10) by differences in concomitant environ-

mental physical conditions: Geomagnetic, Solar and

Cosmic Ray (Neutron) activity.

2. PATIENTS AND METHODS

1) 4633 patients with AMI (2461, 53.12% men) age up

E. Stoupel et al. / HEALTH 2 (2010) 131-136

132

Table 1. Number of stenotic arteries and their maximal stenosis (percentage) in patients with AMI (n-572) and ICS

(n-86). Kaunas, Lithuania, 2000-2005.

Code ICD-10 Maximal Coronary

Stenosis (%) 1 artery (%) 1 + 2 arteries (%) 3 and more ar-

teries (%)

121-122 AMI less than 70 46.9 81.3 18.8

70-99 26.3 51.5 48.5

100 22.0 51.2 48.8

121-122 Total 24.8 53.0 47.0

120.0 ICS less than 70 55.0 80.0 20.0

70-99 17.5 42.5 57.5

100 23.1 38.5 61.5

120.0Total 27.9 50.0 50.0

Grand Total 25.2 52.6 47.4

to 75y. and 961 ICS (654, 68.05% men)—age up to 65y.

treated in Kaunas, Lithuania hospitals at years 2000-

2005-72 consecutive months—were included in this

study. The registry was part of the international MONICA

study registry. In addition, we studied coronary an-

giography data of 572 patients with AMI (code121-122,

ICD 10) and 86 with ICS (code120, ICD 10) comparing

the number of stenotic coronary arteries in both groups (1,

1+2 artery and 3 and more artery disease) and degree of

coronary artery stenosis: <70%, 70-99% and 100% .

2) The monthly distribution of acute cardiovascular

events was compared with concomitant four Solar Activ-

ity (SA) indices, three Geomagnetic activity indices

(GMA) and their antagonist on Earth action—Cosmic

Ray activity indices (CRA) presented by Neutron moni-

toring at the Earth surface in imp/min. Monthly com-

parison was chosen because the precise time of the be-

ginning of the studied clinical events is difficult to fix

hourly or daily and some differences in time of arrival to

the surface of our planet of Solar activity elements- par-

ticles and wave energy components.

3) The physical data was obtained from the Space Sci-

ence institutions in the USA, Russia and Finland. [10-16]

4) Pearson correlation coefficients r and their prob-

abilities p were established for monthly AMI and ICS

number and the mentioned cosmophysical indices.

Probabilities of 95% and higher were described as sig-

nificant; of 90%-94%—as a strong trend toward signifi-

cance. Comparing the number of narrowed coronary

arteries in AMI and ICS groups Chi2 analysis was used,

comparing pathology location and severity; 95% and

higher probability in differences was accepted as sig-

nificant.

3. RESULTS

We made some attempts compare the character of coro-

nary lesions resulting in AMI and ICS in this relatively

young population group (in accord to MONICA protocol).

The age average of the studied patients was 69.12 ±

12.123y. for AMI (64.98 ± 12.21 for men, 73.81 ± 10.17

for women), woman 9 years older and 55.15 ± 7.07y. for

ICS ( 54.1 ± 7.5y. for men and 57.38 ± 5.5 for woman),

woman 3 years older.

Table 1 presents the number of affected by narrowing

(mostly by atherothrombosis) in both groups. In the AMI

group the distribution (in the coronary angiography tested

population) was 1 vessel 24.8%, 1-2 vessels - 53.0% and

3 and more vessel disease in 47.0 %. In the ICS group the

same distribution included 25.2%; 52.5% and 47.4% of

patients. It's difficult to imagine more similar results.

Table 2 presents data about maximal coronary artery

stenoses in both groups: less that 70%, 70-99% and 100%

occlusion. In the AMI group it was only 32 (5.6%) of

maximal stenoses less than 70%. In the ICS (despite not

high number of invasive verification) were 20 (23.3%) of

86. Table 3 presents 70%-100% and 100% ratio in the

AMI and ICS groups. 540 of 572 (94.4%) patients in the

AMI group had maximal stenoses of 70%-100% versus

76.7% (66 of 86 patients) in the ICS group, Chi2 =27.85,

p<0.0001. Comparing total (100%) occlusion in both

groups we found 346 (60.5%) in the AMI group and 26

(30.2%) in ICS, Chi2 =32.04, p<0.0001. Table 4 presents

the interrelationship of both groups of acute cardiac

events with three groups of monthly space physical ac-

tivity parameters SA, GMA, CRA. The AMI group was

inverse correlated (not strong, but significantly) with SA

and related to CRA (Neutron) activity. A different picture

was seen in the ICS: absence of significant links with SA

and CRA (Neutron) activity and links with GMA in the

whole group and men. Absence of such connections in the

woman group that was also more than twice smaller, and

relatively young.

4. DISCUSSION

AMI and ICS, despite many similarities in the etiology,

pathogenesis and natural history have also principal dif-

E. Stoupel et al. / HEALTH 2 (2010) 131-136

133

Table 2. Distribution of maximal coronary stenoses (%) and number of stenotic coronary arteries in patients with

AMI (n-572) and ICS (n-86). Coronary angiography data, 2000- 2005, Kaunas, Lithuania.

Code ICD-10 Maximal Coro-

nary Stenosis (%)

1 artery

disease 2 artery disease 3 artery dis-

ease

4 and more

artery dis-

ease Total

121-122 AMI less than 70 15 11 5 1 32

70-99 51 49 51 43 194

100 76 101 84 85 346

121-122 Total 142 161 140 129 572

120. ICS less than 70 11 5 3 1 20

70-99 7 10 11 12 40

100 6 4 4 12 26

120.0 Total 24 19 18 25 86

Grand Total 166 180 158 154 658

Table 3. Differences in maximal coronary stenoses and number of stenotic coronary arteries in patient with AMI

(n-572) and ICS (n-86).

Coronary Angiography Data, 2000 - 2005, Kaunas, Lithuania

Diagnoses

Maximal

Stenosis

(%)

1 artery dis-

ease 2 artery dis-

ease 3 artery dis-

ease 4 and more

artery disease

Total Differences &

probabilities

AMI 70 - 99 89.4

93.2

96.4

99.2

94.4

ICS 70 - 99 54.2

73.7

83.3

96.0

76.7

}

Chi2=27.85,

p<0.0001

AMI 100 53.5

62.7

60.0

65.9

60.5

ICS 100 25.0

21.1

22.2

48.0

30.2

}

Chi2=32.04,

p<0.0001

Table 4. Data about AMI and ICS environmental Links. KaunaS, 2000 – 2005 pearson correlation coefficients (r) and

their probabilities (p), 72 months data.

Code 121-122 - AMI Code 120.0 - ICS

Male Female Total Male Female Total

Year 0.3 0.29 0.4

Month 1-12 p=0.019 p=0.013 p=0.0017 N.S. N.S. N.S.

Sunspot Number -0.3 -0.263 -0.4

p=0.01 p=0.025 p=0.0021 N.S. N.S. N.S.

Smoothed -0.3 -0.3 -0.355

Sunspot Number p=0.02 p=0.015 0.0022 N.S. N.S. N.S.

Solar Flux -0.3 -0.2 -0.32

2800 MGH 10.7 cm p=0.01 p=0.096 p=0.0066 N.S. N.S. N.S.

Adjusted -0.3 -0.22 -0.33

Solar Flux p=0.01 p=0.067 p=0.004 N.S. N.S. N.S.

GMA Indices:

Ap. 0.3 0.245

N.S. N.S. N.S. p=0.027 N.S. p=0.037

Cp. 0.3 0.24

N.S. N.S. N.S. p=0.028 N.S. p=0.043

Am. 0.3 0.25

N.S. N.S. N.S. p=0.01 N.S. p=0.037

Cosmic Ray 0.2 0,17 0.23

Activity p=0.10 N.S. p=0.048 N.S. N.S. N.S.

Patients Number 2461 2172 4633 654 307 961

E. Stoupel et al. / HEALTH 2 (2010) 131-136

134

ferences. In both types of Acute Coronary Syndrome

(ACS) the role of lipid abnormalities, atheromatous

plaque formation in the coronary arteries is evident

[17–23]. In the last decades the role of inflammation in

the development of ACS is widely discussed and mostly

accepted [19,21]. The role of thrombosis and endothelial

function abnormalities is presented in many studies [21,

20,24].

The cell death of myocytes-necrobiosis and related

acute changes in the necrosis area of supplying the culprit

artery artery is in 75% provoked by plaque rupture or

fissuring with concomitant thrombosis and occlusion,

resulting extreme oxygen transport supply disruption and

leading to cell death, rise of specific enzyme, if prolonged

about 20 minutes or longer are components characteristic

for AMI [21,24,25]. In ICS very similar events of

atheromatous-thrombothic narrowing in the coronary

arteries are accompanied by signs of clinical, ECG,

Echocardiography changes related to drop of myocardial

oxygen supply and his functioning, but the component of

plaque rupture are rare, complete occlusion of the culprit

artery (-ies) not so often and cellular changes mostly

reversible [21-25].

In recent years many studies confirmed the role of en-

vironmental physical factors-solar, cosmic ray — neutron,

geomagnetic, proton flux activity on the timing of oc-

currence, natural history of many cardiovascular pa-

thologies. The mentioned studies included myocardial

infarction, sudden cardiac death, cardiovascular deaths,

stroke etc. [26]

In addition, some of risk factors of Coronary Heart

Disease like arterial pressure, blood lipids and coagula-

tion, C-reactive protein (CRP), life threatening cardiac

arrhythmia (ventricular fibrillation, tachycardia), atrial

fibrillation, cardiac arrhythmia in patients with AMI were

studied in relation to accompanying levels of GMA, CRA,

SA, Space Proton flux of different energy levels. [1-9,

26-32].

Summary of this data can be expressed as follows: both

blood coagulation and inflammation markers, including

such urgent signal reactants like Fibrinogen and CRP, are

rising in high GMA.

Also arterial blood pressure monitoring shows similar

results.

GMA and SA are inverse related to CRA –Neutron ac-

tivity (r=-0.83-0.84, p<0.0001 for SA, r=-0.60, p<0.0001

for GMA in 216 consecutive months) [31].

AMI occurrence (mostly associated with atheroma-

plaque rupture-fissuring [17,18,20,23,22,25] in three

separate studies was correlated with CRA-Neutron ac-

tivity. These findings were confirmed for all subtypes of

AMI-STEMI, NSTEMI, Q Wave and Non Q Wave

groups. [6,26,9].

CRA was also correlated with SCD as a consequence

of AMI, repeated AMI, Myocardial rupture and ather-

othrombosis without AMI- sudden coronary deaths prior

formation of AMI by postmortem data analysis [26].

Life threatening cardiac arrhythmias, detected by im-

plantable cardioverter-defibrillators, mostly in patients

with Ischemic Cardiomyopathy also showed significant

links with daily CRA-Neutron activity [29]. Similar cor-

relation was found exploring the culprit artery in AMI for

lesions predominantly related to Left Anterior Descend-

ing (LAD) coronary artery lesions. LAD related AMI

were accompanied by higher Neutron activity [28].

Right ventricular infarction in AMI related to Right

Coronary Artery (RCA) atherothrombosis, a form of AMI

with higher mortality and AMI of any culprit artery

complicated by cardiogenic shock (mortality still about

60%) are also linked with higher Neutron (CRA) activity

[30]. A recent published study confirmed the changes in

enzyme functioning, a key in most metabolic changes

accompanying acute coronary events, by elementary

particles or radiation [33].

In ICS coronary ischemia event is mostly connected

with thrombosis, atheroma and inflammation related

vascular narrowing and acute ischemic myocardial event

not involving the most critical element- coronary plaque

rupture and sudden or additional thrombosis in the rup-

tured plaque area, resulting acute arterial occlusion and

myocyte necrosis-AMI. The presented maximal stenoses

levels confirm the predominant total or near total arterial

occlusion phenomena in the AMI group compared with

the ICS patients. The action of Neutrons is partially ex-

plained by their damage to human tissues and cells as

they connect free H+ radicals, and transformation to Pro-

tons, attacking, first of all, the cell nuclei and other cel-

lular structures. Neutron activity on the Earth surface

reflects the CRA- the Neutrons are remains of crushed by

Cosmic Rays atoms in the higher parts of the Universe

beyond the SA and GMA terrestrial effects zone. [34-39]

This is the way for an attempt to explain the differences

seen in the physical situation concomitant with the two

groups of acute coronary syndrome (ACS). It’s clear, that

many additional risk factors and ingredients of the

pathogenesis are involved. But in this study we concen-

trated our attention on the role of environmental physical

activity. Some limitations of this study can be mentioned:

1) Absence of elderly patients, especially woman pa-

tients (older 75 in AMI and 65 in ICS groups.

2) Relatively small group of angiography proved

coronary lesions in the ICS patients group; despite this

limitation, the number of invasive studied in ICS was

enough to obtain statistically significant results compar-

ing with AMI patients.

5. CONCLUSIONS

1) Both AMI and ICS patients show significant links by

timing to monthly environmental physical activity.

E. Stoupel et al. / HEALTH 2 (2010) 131-136

135

2) ICS patients show correlation with level of GMA.

Patients with AMI - with CRA.

3) These differences can be a result to diminished role

of plaque disruption and / or fissuring in ICS compared to

AMI.

4) Both groups were similar by number of affected

coronary arteries, but AMI patients suffered from more

critical and total coronary occlusions.

6. ACKNOWLEDGEMENTS

The authors express gratitude to Mr. G.H. Jenkins for his help with the

English version of the manuscript. We are very grateful for the fi-

nancial support from Junta de Castilla y León (JCYL).

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