Vol.2, No.2, 131-136 (2010) Health
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
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.
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
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.
1) 4633 patients with AMI (2461, 53.12% men) age up
E. Stoupel et al. / HEALTH 2 (2010) 131-136
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
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 monthswere 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 actionCosmic
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-
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.
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
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
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-
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
1 artery dis-
ease 2 artery dis-
ease 3 artery dis-
ease 4 and more
artery disease
Total Differences &
AMI 70 - 99 89.4
ICS 70 - 99 54.2
AMI 100 53.5
ICS 100 25.0
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
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
ferences. In both types of Acute Coronary Syndrome
(ACS) the role of lipid abnormalities, atheromatous
plaque formation in the coronary arteries is evident
[1723]. 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,
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,
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
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). Its 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.
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
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
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
4) Both groups were similar by number of affected
coronary arteries, but AMI patients suffered from more
critical and total coronary occlusions.
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).
[1] Stoupel, E., Joshua, H., Lahav, J. (1996) Human blood
coagulation parameters and geomagnetic activity. Eur J
Int Med, 7, 217-220.
[2] Stoupel, E., Wittenberg, C., Zabludovski, J., Boner, G.
(1995) Ambulatory blood pressure monitoring in patients
with hypertension on days of high and low geomagnetic
activity. J Human Hypertension, 9, 293-294.
[3] Stoupel, E., Abramson, E., Israelevich, P., Sulkes, J.,
Harell, D. (2007) Dynamics of serum C-reactive protein
(CRP) level and cosmophysical activity. Eur J Int Med,
18(2), 124-128.
[4] Stoupel, E. (1980) Solar-terrestrial predictions: Aspects
for preventive medicine in: Donnelly Ed. solar-terrestrial
predictions. Vol 4. NOAA Space Environment Laboratory
and USAF, Boulder, Co., USA, G29-G40.
[5] Oranevskii, V.N., Breus, T.K., Baevskii, R.M., Rappoprt,
S.I., Petrov, V.M., Barsukova, Z.V. (1998) Effect of geo-
magnetic activity on the functional status of the body.
Biofizika, 43(5), 819-826.
[6] Stoupel, E., Domarkiene, S., Radishauskas, R., Bernotiene,
G., Abramson, E., Israelevich, P., Sulkes, J. (2004) Links
between monthly rates of four subtypes of acute myocar-
dial infarction and their corresponding cosmophysical
activity parameters. J Basic & Clin Physiol & Pharmacol,
15(3-4), 175-184.
[7] Gurfinkel, Y.I., Liubimov, V.V., Orajevskii, V.N., Par-
fenova, L.M., Yurjev, A.S. (1995) The influence of geo-
magnetic activity on capillary flow in ischemic heart
disease patients. Biofizika, 40(4), 793-799.
[8] Nuzhdina, M.A. (1998) Effect of natural factors on the
occurrence of cardiovascular diseases. Biofizika, 43(4)
[9] Stoupel, E., Babayev, E., Mustafa, F., Abramson, E.,
Israelevich, P., Sulkes, J. (2007) Acute myocardial In-
farction occurrence: Environmental links - Baku
2003-2005 data. Med Sc Monit, 13(8), BR 175-179.
[10] NOAA National Geophysical Data Center. Solar Indices
[11] NOAA National Geophysical Data Center. Geomagnetic
Indices Bulletin.
[12] NOAA, SWPC USAF Preliminary Report and Forecast
of Solar Geophysical Data.
[13] Russian Academy of Sciences. Izmiran Institute. Cosmic
[14] Russian Academy of Sciences. Moscow Neutron Moni-
toring Data.
[15] Oulu University. Neutron Monitoring Data, 15.
[16] NOAA-USAF. (1988) SESC glossary of solarterrestrial
terms. Boulder, CO, USA, 1-69.
[17] Fuster, V. (1999) The vulnerable atherosclerotic plaque.
Blackwell Publishing.
[18] Fuster, V., Fayad, Z.A., Badimon, J.J. (1999) Acute coro-
nary syndromes. Lancet 353, Suppl., 2, S114-119.
[19] Libby, P., Ridker, P.M., Maseri, A. (2002) Inflammation
and atherosclerosis. Circulation, 105(9), 1135-1143.
[20] Topol, E. (2005) Atlas of Atherothrombosis. Current
Medical Group. 2004 London.
[21] Gawaz, M. (2006) The evolving science of atherothrom-
botic disease Eur heart J Suppl. Antiplateled Strategies in
Patients Undergoing Interventions with Acute Coronary
Syndrome Ed. J.-F. Neumann, 10(1), 14-17.
[22] Solem, J., Levin, M., Karlsson, T., Grip, L., Albertson, P.,
Wiklund, O. (2006) Composition of coronary plaque ob-
tained by directional atherectomy in stable angina: its re-
lation to serum lipids and statin treatment. J Int Med, 259
(3), 267-275.
[23] Tanaka, A., Shimada, K., Numba, M., Sakamoto, T., Na-
kamura, Y., Nishida, V.Y., Yoshikawa, J., Akasaka, T.M.,
Relationship between longitudinal.
[24] (2008) Morphology of ruptured plaques and TIMI flow
grade in acute coronary syndrome: a three-dimensional
intravascular ultrasound imaging study. Eur Heart J, 29,
[25] De Catherina, R., Husted, S., Walentin, L. et al. (2007)
ESC position paper v. Anticoagulants in heart disease:
current status and perspectives. Eur Heart J, 28(7),
[26] Thigesen, K., Alpert, J.S. (2007) White HD on behalf the
ESC/ACCF/AHA/ WHF task force universal definition of
myocardial infarction. European Heart Journal, 28,
[27] Stoupel, E. (2002) The effect of geomagnetic activity on
cardiovascular parameters. Biomedicine & Pharmaco-
therapy. 56, 247-256.
[28] Stoupel, E., Domarkiene, S., Radishauskas, R., Abramson,
E., Israelevich, P., Sulkes, J. (2006) Neutrons and Sudden
Cardiac Deaths (SCD) Codes 121-125 ICD 10. Basic &
Clin Physiol & Pharmacol, 17(1), 45-53.
[29] Stoupel, E., Assali, A., Teplitzky, I., Abramson, E., Is-
raelevich, P., Sulkes, J. (2008) The culprit artery in acute
myocardial infarction in different environmental physical
activity levels. Intern J Cardiol, 126, 266-290.
[30] Stoupel, E., Kusniec, J., Mazur, J., Abramson, E., Is-
raelevich, P., Strasberg, B. (2008) Timing of life-threat-
ening arrhythmias detected by implantable cardioverter-
defibrillators in relation to changes in cosmophysical
factors. Cardiology J, 15(5), 1-4.
[31] Stoupel, E., Assali, A., Teplitzky, I., Vaknin-Assa, H.,
Abramson, E., Israelevich, P., Kornowski, R. (2009)
Physical influences on right ventricular infarction and
cardiogenic shock in acute myocardial Infarction. Basic &
E. Stoupel et al. / HEALTH 2 (2010) 131-136
SciRes Copyright © 2010 Openly accessible at http://www.scirp.org/journal/HEALTH/
Clin Physiol & Pharmacol, 20(1), 83-90.
[32] Stoupel, E., Kalediene, R., Petrauskiene, J., Starkuviene,
S., Abramson, E., Israelevich, P., Sulkes, J. (2009) Death-
optimal physical conditions. The 56th Annual Conference
of the Israeli Heart Society, Program and Abstracts. 119,
[33] Stoupel, E., Babayev, E., Mustafa, F., Abramson, E.,
Israelevich, P., Sulkes, J. (2003-2005) (2006) Clinical
cosmobiology: Sudden cardiac death and daily /monthly
geomagnetic-cosmic ray and solar activity. The Baku
Study. Sun & Geosphere, 1(2), 13-16.
[34] Kirby, A.J., Hollffelder, F. (2008) Enzymes under the
nanoscope. Nature, 456(6), 45-47.
[35] Nias, A.H.V. (1999) An introroduction to radiotherapy.
John Wiley & Sons, NY.
[36] The Pierre Auger collaboration. (2007) Correlation of the
HighestEnergy Cosmic Rays with Nearby Extragalactic
Objects, Science, 318(5852), 938-943.
[37] Johnston, H. (2008) Cosmic-ray mystery solved at last.
http://physicsworld.com/cws/article/news/, 31764, 1-3.
[38] Cho, A. (2007) Universe's Highest-Energy Particles
Traced Back to Other Galaxies Science, 318, 896-897.
www.sciencemag.org (Accessed December 24).