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Differential progression of complex and smooth stenoses within the same coronary tree in men with stable coronary
M R Chester1, L Chen, D Tousoulis
1Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, United Kingdom.
Insights
Complex coronary stenoses progress more rapidly than smooth ones in patients with stable coronary artery disease. Stenosis morphology is a key factor in disease progression, even in clinically stable patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Coronary Artery Disease
Background:
- Coronary stenosis progression impacts prognosis and is influenced by local and systemic factors.
- Stenosis morphology is a known determinant of disease progression.
- Previous studies have not systematically compared complex and smooth stenoses within the same patient.
Purpose of the Study:
- To compare the progression of complex versus smooth coronary stenoses within the same patient.
- To investigate the influence of stenosis morphology on disease evolution in stable coronary artery disease.
Main Methods:
- 50 men with stable angina and one complex and one smooth stenosis were studied.
- Quantitative coronary angiography was performed at baseline and after a median of 9 months.
- Exclusion criteria included long lesions, lesions at branching points, or >85% diameter reduction.
Main Results:
- Progression (>15% diameter stenosis increase) occurred in 16% of complex stenoses but 0% of smooth stenoses (p<0.01).
- Complex stenoses showed significantly greater changes in severity compared to smooth stenoses (5.8% vs. -0.06%, p<0.01).
- The annual growth rate was substantially higher for complex lesions (11.4%) than smooth lesions (1.5%, p<0.01).
Conclusions:
- Coronary stenoses show limited rapid progression in stable angina.
- Complex and smooth coronary stenoses exhibit different progression rates within the same arterial tree.
- Stenosis morphology is a critical determinant of progression in patients with clinically stable coronary artery disease.
Objectives:
We sought to compare the evolution of complex and smooth stenoses within the same coronary tree in patients with stable coronary artery disease.
Background:
Progression of coronary stenosis has prognostic significance and may be influenced by local and systemic factors. Stenosis morphology is a determinant of disease progression, but no previous study has systematically assessed progression of complex and smooth stenoses within the same patient.
Methods:
We studied 50 men with stable angina who 1) had one complex coronary stenosis and one smooth stenosis in different noninfarct-related coronary vessels at initial coronary angiography, and 2) had a second angiogram after a median interval of 9 months (range 3 to 24). Patients with lesions > or = 10 mm long, at a major branching point or with > 85% diameter reduction were not included. Coronary lesions were measured quantitatively from comparable end-diastolic frames. Stenosis morphology was determined qualitatively by two independent observers.
Results:
All patients remained in stable condition during follow-up. Progression, defined as an increase in diameter stenosis by > or = 15% was seen in only eight complex stenosis (16%) but in no smooth lesions (p < 0.01). The severity of complex stenoses changed more than that of corresponding smooth stenoses (mean +/- 1 SD 5.8 +/- 13% vs. -0.06 +/- 6%, p < 0.01). On average, the annual rate of growth was 11.4 +/- 28% and 1.5 +/- 14% for complex and smooth lesions, respectively (p < 0.01).
Conclusions:
Few coronary stenoses progress rapidly in stable angina. Complex and smooth coronary stenoses progress at different rates within the same coronary tree. complex stenosis morphology itself is an important determinant of progression of stenosis in patients with apparently clinically stable coronary artery disease.