Rapid angiographic progression of coronary artery disease in patients with angina pectoris. The role of complex stenosis morphology.
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.
Kaski
J C
JC
Department of Cardiological Sciences, St George's Hospital Medical School, London, UK.
Chester
M R
MR
Chen
L
L
Katritsis
D
D
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