title: Rapid angiographic progression of coronary artery disease in patients with angina pectoris. The role of complex stenosis morphology.
abstract: BACKGROUND
  Rapid disease progression commonly underlies acute coronary events, and "complex" stenosis morphology may play a role in this phenomenon.
  
  
  RESULTS
  We studied the role of complex stenosis morphology in rapid disease progression in 94 consecutive patients awaiting routine coronary angioplasty. Coronary arteriography was repeated at 8 +/- 3 months' follow-up, immediately preceding angioplasty (68 patients) or after an acute coronary event (26 patients). Disease progression of 217 stenoses, of which 79 (36%) were "complex" and 138 (64%) were "smooth," was assessed by computerized angiography. At presentation, 63 patients had stable angina pectoris and 31 had unstable angina that settled rapidly with medical therapy. At follow-up, 23 patients (24%) had progression of preexisting stenoses and 71 (76%) had no progression. Patients with progression were younger (55 +/- 12 years) than those without (58 +/- 9 years) but did not differ with regard to risk factors, previous myocardial infarction, or severity and extent of coronary disease. Twenty-three lesions (11%) progressed, 15 to total occlusion (11 complex and 4 smooth; 65%). Progression occurred in 17 of the 79 complex stenoses (22%) and in 6 of the 138 smooth lesions (4%) (P = .002). Mean stenosis diameter reduction was also significantly greater in complex than in smooth lesions (11.6% versus 3.9% change; P < .001). Acute coronary events occurred in 57% of patients with progression compared with 18% of those without progression (P < .001) and were more frequent in patients who presented with unstable angina (P = .002).
  
  
  CONCLUSIONS
  Rapid stenosis progression is not uncommon, and complex stenoses are at risk more than smooth lesions.
authors.affiliation: Department of Cardiological Sciences, St George's Hospital Medical School, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Kaski
authors.forename: M R
authors.initials: MR
authors.lastname: Chester
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Katritsis
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors