Plaque progression in coronary arteries with minimal luminal obstruction in intravascular ultrasound atherosclerosis trials.
The relation among the burden of disease, progression of atherosclerosis, and remodeling in angiographically minimally diseased coronary arteries has not been defined. The present analysis included 1,906 patients who participated in 5 prospective clinical trials examining atheroma progression using intravascular ultrasonography. For the present analysis, the patients were stratified according to baseline quantitative coronary angiographic stenosis: <20%, 20% to 35%, and >35%. Patients with a lesser degree of luminal stenosis had less atherosclerosis. However, in the arteries with minimal angiographic stenosis, a large percentage of images contained atheroma, demonstrating the diffuse nature of coronary atherosclerosis. All 3 groups showed evidence of disease progression. The serial changes in vessel dimensions revealed that both the external elastic membrane and lumen volumes decreased in all 3 subgroups, in keeping with vessel and luminal constriction. In conclusion, these findings have demonstrated that patients with at least one luminal stenosis have diffuse atherosclerosis that progressed during 18 to 24 months, making them a target for therapeutic intervention. These minimally diseased arteries demonstrated evidence of vessel and luminal constriction, regardless of the angiographic appearance.
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Andrea J
AJ
Lavoie
Ozgur
O
Bayturan
Kiyoko
K
Uno
Amy
A
Hsu
Kathy
K
Wolski
Paul
P
Schoenhagen
Samir
S
Kapadia
E Murat
EM
Tuzcu
Steven E
SE
Nissen
Stephen J
SJ
Nicholls
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional / Q000379:methods*
D000924:Anticholesteremic Agents