Coronary stenosis progression differs in patients with stable angina pectoris with and without a previous history of
1Department of Cardiological Sciences, St. George's Hospital Medical School, London, U.K.
Insights
Coronary artery stenoses linked to prior unstable angina events show significantly higher progression rates than those without such history. This highlights the potential for unstable plaques to worsen, even after periods of clinical stability.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Atherosclerosis Research
Background:
- Acute coronary syndromes (ACS) are often caused by the progression of coronary artery stenoses.
- Understanding the factors influencing stenosis evolution is crucial for predicting and preventing ACS.
- The clinical behavior of coronary plaques, even those appearing stable, requires further investigation.
Purpose of the Study:
- To compare the progression of coronary stenoses associated with acute coronary events versus those not.
- To investigate the role of prior unstable angina history in stenosis evolution.
- To assess the impact of stenosis morphology (complex vs. smooth) on progression.
Main Methods:
- Prospective study of 190 patients with stable angina and single-vessel disease awaiting coronary angioplasty.
- Patients categorized into Group 1 (previous unstable angina history) and Group 2 (no history).
- Angiographic assessment of stenosis progression at 8 ± 4 months, classifying stenoses as 'complex' or 'smooth'.
Main Results:
- Stenosis progression occurred in 19% of Group 1 patients versus 6% in Group 2 (P = 0.0044).
- Complex stenoses showed higher progression (19%) compared to smooth stenoses (5%) (P = 0.003).
- Coronary events were more frequent in Group 1 patients (12 vs. 9, P = 0.02).
Conclusions:
- Coronary stenoses in stable angina patients with a history of unstable angina are more prone to progression.
- Unstable atherosclerotic plaques can progress rapidly to total occlusion, even after >3 months of clinical stability.
- These findings underscore the importance of considering plaque instability in managing coronary artery disease.
Objectives:
To compare the evolution of stenoses responsible for acute coronary events with those not associated with acute coronary syndromes.
Methods And Results:
We prospectively studied angiographic stenosis progression in 190 stable angina patients, with single vessel disease, who were awaiting non-urgent coronary angioplasty. Sixty four patients had a previous history of unstable angina (Group 1) and 126 patients had no history of unstable angina (Group 2). Culprit stenoses were classified as "complex' or "smooth'. At restudy, 8 +/- 4 months after the first angiogram, 12 of 63 culprit stenoses in Group 1 had progressed and seven of 125 in Group 2 (19% vs 6%, P = 0.0044). Thirteen of 68 complex culprit stenoses had progressed, compared with only 6 of 120 smooth culprit stenoses (19% vs 5%, P = 0.003). Coronary events occurred in 12 Group 1 patients and nine Group 2 patients (P = 0.02).
Conclusions:
In patients with stable angina, stenoses associated with previous episodes of unstable angina are more likely to progress than stenoses not associated with previous unstable angina. Unstable coronary atherosclerotic plaques, even those that have been clinically stable for more than 3 months, may retain the potential for rapid progression to total occlusion.
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