Related Experiment Videos
[A prospective study of the evolution of coronary lesions: clinico-morphologic correlations]
E Corrada1, A Mafrici, P Salvadé
1Dipartimento di Cardiologia A. De Gasperis Ospedale Niguarda, Ca' Granda, Milano.
Insights
Coronary atherosclerosis progression occurred in 23% of patients, while regression was observed in 11%. Lesion length and severity influenced progression, and regression was noted in recently infarcted areas.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Coronary atherosclerosis is a progressive disease, but its natural evolution, including regression, is not fully understood.
- Understanding the dynamics of coronary lesions is crucial for managing cardiovascular disease.
Purpose of the Study:
- To evaluate the progression and regression of coronary atherosclerosis over one year in patients with various coronary artery disease manifestations.
- To identify factors associated with lesion progression and regression.
Main Methods:
- Prospective study of 61 patients undergoing serial coronary angiography (baseline and one year).
- Patients included stable angina, unstable angina, recent myocardial infarction, and treated multivessel disease.
- Repeat angiography was performed in 13 patients for clinical reasons.
Main Results:
- Progression of coronary atherosclerosis was observed in 23% of patients (7% of stenoses).
- Regression of coronary lesions occurred in 11% of patients (5% of lesions).
- Progression was more frequent in longer stenoses (>5 mm) and severe lesions (≥75% diameter reduction). Regression was more frequent in occluded vessels supplying recently infarcted areas. Plaque morphology did not significantly correlate with progression or regression.
Conclusions:
- Coronary atherosclerosis can exhibit both progression and regression over a one-year period.
- Lesion characteristics like length and severity are associated with progression, while regression is linked to specific vascular territories.
- Clinical status did not strongly correlate with angiographic changes, although regression was associated with the absence of new cardiac events.
Abstract:
In order to evaluate the evolution (progression and regression) of coronary atherosclerosis, 61 patients (8 with stable angina, 9 with unstable angina, 15 with a recent myocardial infarction, 29 with multivessel coronary artery disease and treated with successful one-vessel angioplasty) were enrolled in a prospective study. In the angioplasty group, only untreated vessels were considered for the analysis. All patients underwent coronary angiography before hospital discharge and after one year, in accordance with the study protocol. In 13 patients (21%) a repeat angiography was performed at 6.3 +/- 2.7 months for clinical reasons (myocardial infarction, changing pattern angina, angina recurrence). All patients were asymptomatic or mildly symptomatic on medical therapy between the angiographic studies. Progression (decrease in internal luminal diameter at the site of stenosis greater than or equal to 20%; new onset of lesions, new episodes of total occlusions) was found in 16 out of 216 stenoses (7%) and in 14 out of 61 patients (23%). Regression (increase greater than or equal to 20% in internal luminal diameter; reopening of a previously occluded vessel) was found in 11 out of 227 lesions (5%) and in 7 out 61 patients (11%). At repeat angiography, the increase in severity was found more frequently in stenoses greater than 5 mm in length and with a reduction of greater than or equal to 75% in luminal diameter. Regression was more frequent in the occluded vessel supplying a recently infarcted area. No significant relationship was observed between lesion morphology (concentric, eccentric, with plaque ulceration, thrombi, border irregularities) and progression or regression. Lesions with plaque ulceration (with or without superimposed thrombi) were found only in patients submitted to coronary angiography close to an acute ischemic attack. Morphologic regression (disappearance of ulceration, border irregularities, thrombi) was also observed, without any significant changes occurring in the severity of the underlying stenosis. Progression may occur independently of worsening in the clinical status; on the contrary, regression was only found in patients without new cardiac events. Nevertheless, clinical status does not seem to be closely correlated to progression, regression, or changes in plaque morphology.