(Circulation. 1995;91:2319-2324.)
© 1995 American Heart Association, Inc.
Articles |
Angiographic Stenosis Progression and Coronary Events in Patients With `Stabilized' Unstable Angina
From the Coronary Artery Disease Research Group, Department of Cardiological Sciences, St George's Hospital Medical School, London, England.
Correspondence to Dr Juan Carlos Kaski, Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Background Recent studies suggest that angiographically complex coronary stenoses are associated with an adverse short-term outcome. It is not known, however, if this applies to unstable angina patients who stabilize on medical therapy.
Methods and Results We prospectively studied 85 consecutive
patients with unstable angina who stabilized on medical therapy but
were found to require angioplasty for treatment of obstructive coronary
disease. Angiography was carried out at admission, and patients were
restudied 8±4 months (mean±SD) after the first angiogram.
Ischemia-related stenoses were identified and classified as
"complex" (irregular borders, overhanging edges, or thrombus) or
"smooth" (absence of complex features). Stenosis progression
(
20% diameter reduction or new total occlusion) was assessed by
automated edge detection. At initial angiography, there were 198
stenoses (50%, 102), of which 85 (54 complex and 31 smooth) were
ischemia related. At restudy, 21 ischemia-related stenoses and 8
non–ischemia-related stenoses progressed (25% versus 7%,
P=.001). Seventeen of the 21 ischemia-related stenoses that
progressed developed into total occlusion compared with 3 of the 8
non–ischemia-related stenoses (P=.02). Changes in
average
stenosis severity and in absolute stenosis diameter were significantly
larger in ischemia-related stenoses than in non–ischemia-related
stenoses (P=.03). Eighteen (34%) complex stenoses
progressed, compared with 3 (10%) smooth lesions (P=.02).
During follow-up, 1 patient died (myocardial infarction) and 25
patients had nonfatal coronary events that were associated with
progression of ischemia-related stenoses in 14 (56%).
Conclusions In unstable angina patients who stabilize medically, subsequent short-term stenosis progression and coronary events are common. The unstable coronary lesion (particularly complex stenoses) is often not stabilized and will continue to progress over the ensuing months.
Key Words: angina • coronary disease • ischemia • stenosis • angiography
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