Related Experiment Videos
Differential progression of complex culprit stenoses in patients with stable and unstable angina pectoris
1Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, United Kingdom.
Insights
Complex stenoses in unstable angina patients progress more often than in stable angina patients, frequently leading to recurrent coronary events. This highlights differences in coronary stenosis evolution between angina types.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Complex coronary stenoses are linked to adverse clinical and angiographic outcomes.
- The differential evolution of complex stenoses in unstable angina versus stable angina remains unclear.
Purpose of the Study:
- To compare the progression of complex culprit stenoses in patients with stable angina versus unstable angina pectoris.
Main Methods:
- Prospective assessment of stenosis progression in 95 unstable angina patients and 200 stable angina patients.
- Patients underwent repeat angiography 8 months later to evaluate stenosis changes.
- Culprit stenoses were classified as complex (irregular borders, overhanging edges, thrombus) or smooth; progression was defined as ≥20% diameter reduction or total occlusion.
Main Results:
- Culprit stenoses progressed more frequently in unstable angina patients (15%) compared to stable angina patients (7%) (p=0.001).
- Complex culprit stenoses showed greater progression in the unstable angina group (p=0.01).
- Complex morphology and unstable angina at presentation were significant predictors of culprit stenosis progression.
Conclusions:
- A higher proportion of complex culprit stenoses progress in unstable angina patients compared to stable angina patients.
- Progression of culprit complex stenoses in unstable angina is often associated with recurrent coronary events.
Objectives:
This study sought to compare the evolution of complex culprit stenoses in patients with stable and those with unstable angina pectoris.
Background:
Complex coronary stenoses are associated with adverse clinical and angiographic outcomes. However, it is not known whether the evolution of complex stenoses differs in unstable angina versus stable angina pectoris.
Methods:
We prospectively assessed stenosis progression in 95 patients with unstable angina whose angina stabilized with medical therapy (Group 1) and 200 patients presenting with stable angina (Group 2). After diagnostic angiography, all patients were placed on a waiting list for coronary angioplasty and restudied at 8 +/- 4 (mean +/- SD) months later. In each patient the presumed culprit stenosis was identified and classified as complex (irregular borders, overhanging edges or thrombus) or smooth (absence of complex features). Stenosis progression, as assessed by computerized angiography, was defined as > or = 20% diameter reduction or new total occlusion.
Results:
At the first angiogram, 364 stenoses > or = 50% and 383 stenoses < 50% were identified. At restudy, 36 (15%) of 236 stenoses progressed in 29 Group 1 patients and 36 (7%) of 502 stenoses in 31 Group 2 patients (p = 0.001). Forty-five (88%) of 51 stenoses > or = 50% and 6 (29%) of 21 stenoses < 50% that progressed developed to total coronary occlusion (p = 0.001). More culprit stenoses progressed in Group 1 than in Group 2 (p = 0.006), whereas progression of nonculprit stenoses was not significantly different in both groups. Culprit complex stenoses progressed more frequently in Group 1 than in Group 2 (p = 0.01). During follow-up, 3 patients died (myocardial infarction), and 51 had a nonfatal coronary event. Culprit stenoses progressed in 15 (54%) of the 28 patients with a nonfatal coronary event in Group 1 and in 9 (39%) of 23 patients in Group 2 (p = NS). Complex morphology (p < 0.001) and unstable angina at initial presentation (p < 0.01) were predictive factors for progression of culprit stenoses.
Conclusions:
A larger proportion of culprit complex stenoses progress in unstable angina than stable angina, and this is frequently associated with recurrence of coronary events.