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Coronary artery disease: arterial remodelling and clinical presentation
P C Smits1, G Pasterkamp, M A Quarles van Ufford
1Department of Cardiology, Heart Lung Institute, University Hospital Utrecht, Netherlands. smits@cardio.azr.nl
Insights
In coronary artery disease, larger plaques in enlarged artery segments correlate with acute coronary syndromes. Smaller plaques in shrunken segments are linked to stable angina pectoris, influencing clinical presentation.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) involves plaque buildup in arteries.
- Vessel remodelling, the process of compensatory enlargement or shrinkage, plays a role in CAD progression.
- Understanding plaque size and vessel remodelling in relation to clinical syndromes is crucial for patient management.
Purpose of the Study:
- To test if plaque size and vessel remodelling patterns differ between stable angina and acute coronary syndromes.
- To determine if enlarged arterial segments with large plaques are associated with acute coronary syndromes (ACS).
- To investigate if shrunken segments with smaller plaques are associated with stable angina pectoris (SAP).
Main Methods:
- Patients undergoing percutaneous transluminal coronary angioplasty (PTCA) were categorized into stable (n=37) and unstable (n=32) angina groups.
- Intravascular ultrasound assessed vessel remodelling at culprit lesion sites before PTCA.
- Remodelling was quantified as relative vessel area; compensatory enlargement was defined as >=105%, shrinkage as <=95%.
Main Results:
- Unstable angina patients had larger vessel areas and plaque areas at culprit sites compared to stable angina patients.
- Significantly more stable angina patients exhibited shrunken culprit lesion sites (21/37) versus unstable angina patients (8/32).
- Conversely, more unstable angina patients showed enlarged culprit lesion sites (16/23) compared to stable angina patients (8/37).
Conclusions:
- Vessel remodelling patterns are significantly associated with the clinical presentation of coronary artery disease.
- Compensatory enlargement of arterial segments may predispose to acute coronary syndromes.
- Arterial shrinkage is more characteristic of stable angina pectoris.
Objective:
To investigate the hypothesis that in coronary artery disease large plaques in compensatorily enlarged segments are associated with acute coronary syndromes, whereas smaller plaques in shrunken segments are associated with stable angina pectoris.
Methods:
Patients selected for percutaneous transluminal coronary angioplasty (PTCA) were divided into two groups, one with stable angina pectoris (stable group, n = 37) and one with unstable angina or postmyocardial infarction angina of the infarct related artery (unstable group, n = 32). In both groups, remodelling at the culprit lesion site was determined by intravascular ultrasound before the intervention. Remodelling was calculated as relative vessel area: [vessel area culprit lesion site / mean vessel area of both proximal and distal reference sites] x 100%. Compensatory enlargement was defined as remodelling of >/= 105%, whereas shrinkage was defined as remodelling of
Results:
In the unstable group, the vessel area at the culprit lesion site was larger than in the stable group, at mean (SD) 18.1 (5.3) v 14.6 (5.4) mm(2) (p = 0.008). Lumen areas were similar. Consequently, plaque area and percentage remodelling were larger in the unstable group than in the stable group: mean (SD) 14.8 (4.8) v 11.6 (4.9) mm(2) (p = 0.009) and 112 (31)% v 95 (17)% (p = 0.005), respectively. Significantly more culprit lesion sites were classified as shrunken in the stable group (21/37) than in the unstable group (8/32; p = 0.014). On the other hand, more lesion sites were classified as enlarged in the unstable group (16/23) than in the stable group (8/37; p = 0.022).
Conclusions:
In patients selected for PTCA, the mode of remodelling is related to clinical presentation.