title: Clinical classification and plaque morphology determined by optical coherence tomography in unstable angina pectoris.
abstract: Unstable angina pectoris (UAP) is categorized with the Braunwald classification. However, the association of clinical presentation and plaque structure/function has not yet been elucidated in relation to cause. We used optical coherence tomography to investigate this relation. One hundred fifteen patients with primary UAP were categorized according to the Braunwald classification. Patients with class I UAP had the highest frequency of ulcers without fibrous cap disruption (p = 0.003) and the smallest minimum lumen area (class I, median 0.70 mm(2), quartiles 1 to 3 0.42 to 1.00; class II, 1.80 mm(2), 1.50 to 2.50; class III, 2.31 mm(2), 1.21 to 3.00; p <0.001). Patients with class II UAP had the highest frequency of coronary spasm (p <0.001) and the lowest frequency of thrombi (p <0.001). Patients with class III UAP had the highest frequency of plaque ruptures (p <0.001), the thinnest fibrous cap (class I, median 140 microm, quartile 1 to 3 90 to 160; class II, 150 microm, 120 to 160; class III, 60 microm, 40 to 105; p <0.001), and the highest frequency of thin cap fibroatheromas (p <0.001) and spotty calcifications (p <0.001). In conclusion, the structures/functions of culprit lesions on optical coherence tomograms differ in the Braunwald classes of UAP. Plaque vulnerability, progressive stenosis, and vasoconstriction may be related to the cause of the distinct presentations.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Mizukoshi
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.forename: Shigeho
authors.initials: S
authors.lastname: Takarada
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komukai
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000145:classification* / Q000000981:diagnostic imaging; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D041623:Tomography, Optical Coherence