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Diffuse extent of coronary atherosclerosis in fatal coronary artery disease
1Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Insights
Atherosclerotic plaques severely narrow major coronary arteries in patients with coronary artery disease. Unstable angina patients showed the most significant artery narrowing, indicating advanced disease progression.
Area of Science:
- Cardiovascular Pathology
- Atherosclerosis Research
- Coronary Artery Disease
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Atherosclerosis, the buildup of plaques in arteries, is the primary driver of CAD.
- Understanding the extent and distribution of arterial narrowing is crucial for disease management.
Purpose of the Study:
- To quantify the degree of atherosclerotic narrowing in the four major epicardial coronary arteries.
- To compare the extent of narrowing across different clinical subsets of coronary artery disease patients.
- To assess the overall severity and distribution of atherosclerosis in fatal CAD cases.
Main Methods:
- Necropsy study of 129 patients with coronary artery disease and 40 control subjects.
- Analysis of four major epicardial coronary arteries (left main, left anterior descending, left circumflex, right).
- Histological examination of 5-mm arterial segments (6,461 from patients, 1,849 from controls) stained using the Movat method.
Main Results:
- Patients with CAD had an average of 2.7 significantly narrowed ( >75%) arteries versus 0.7 in controls.
- Unstable angina patients exhibited the highest incidence of narrowed arteries (3.2) and severely narrowed segments (48%).
- 92% of all analyzed coronary segments showed narrowing greater than 25%, with 35% severely narrowed (75-100%) in CAD patients.
Conclusions:
- Atherosclerosis is a severe and diffuse process affecting major epicardial coronary arteries in patients with fatal CAD.
- The degree of arterial narrowing correlates with specific clinical presentations of coronary artery disease.
- These findings highlight the extensive nature of atherosclerotic burden in advanced CAD.
Abstract:
In 4 subsets of patients with coronary artery disease, the amounts of narrowing of the 4 major epicardial coronary arteries were compared (left main, left anterior descending, left circumflex and right) by atherosclerotic plaques. Among 129 patients studied at necropsy, an average of 2.7 of the 4 arteries were narrowed greater than 75% in cross-sectional area at some point; in control subjects, narrowing was seen in an average of 0.7 arteries. Patients with unstable angina pectoris had a greater incidence of narrowing (3.2 arteries) than did patients with sudden coronary death (2.8), acute myocardial infarction (MI) (2.7) or healed MI (2.3). Each of the 4 major arteries was divided into segments 5 mm in length, and histologic sections were prepared and stained by the Movat method. A total of 6,461 segments were analyzed from the 129 patients and 1,849 from the 40 controls. In the 129 patients, 35% of the 5-mm segments were narrowed 75 to 100% in cross-sectional area (compared with 3% in control subjects). The group with unstable angina had the highest percentage (48%) of severely narrowed segments compared with the groups with sudden coronary death (36%), acute (34%) and healed MI (31%). Only 8% of the 6,461 segments were narrowed less than or equal to 25% in cross-sectional area, and virtually none of the 6,461 segments was normal; thus, 92% of the coronary segments were narrowed greater than 25% in cross-sectional area by atherosclerotic plaque alone. Among patients with fatal coronary artery disease studied at necropsy, therefore, the atherosclerotic process is severe and diffuse in the major epicardial coronary arteries.