Mechanisms of progression in native coronary artery disease: role of healed plaque disruption
Population
31 men aged 51-69 dying suddenly of ischaemic heart disease, providing 39 coronary arteries containing 256…
Design
Cross-sectional, Each section was read independently by two observers
Authors
Discussion
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Implication
Associated with advanced stenosis; supports healed disruption as driver of progression but hypothesis-generating and needs prospective validation.
Key Points
- This research aims to investigate how healed plaque disruption contributes to the development of severe coronary artery stenosis.
- Perfuse fixation of coronary arteries at necropsy with formal saline for histological examination.
- Measurement of percentage lumen diameter stenosis in 3 mm segments of plaque.
- Analysis of plaques using Sirius red staining and immunohistochemistry for smooth muscle actin.
- 16 of 99 plaques causing <20% diameter stenosis had prior healed disruption.
- In the 21-50% stenosis range, 16 of 86 plaques showed a healed disruption pattern.
- In plaques with stenosis ≥ 51%, 52 out of 71 exhibited healed disruption, with significant differences (p < 0.001).
Structured PICO
P
Population
31 men aged 51-69 dying suddenly of ischaemic heart disease, providing 39 coronary arteries containing 256 separate plaques (excluding old total occlusions, acute culprit thrombotic lesions, diffuse disease without normal arterial segments, and arteries related to old myocardial scars).
O
Outcome
Presence of healed plaque disruption across different degrees of percentage lumen diameter stenosissurrogate
Subclinical episodes of plaque disruption followed by healing are a major mechanism driving the sudden, phasic progression of chronic high-grade coronary stenosis.
Cite This Study
Mann et al. (1999) studied this question.