Type 1 marked progression of coronary lesions was associated with sudden severe stenosis and a high rate of angina or myocardial infarction (71%) compared to Type 2 continuous slight progression (14%).
Observational (n=36)
Coronary artery disease progresses via two distinct mechanisms: sudden marked progression linked to plaque rupture and clinical events, and continuous slight progression linked to systemic inflammation.
Absolute Event Rate: 71% vs 14%
BACKGROUND: The process of progression in coronary artery disease is unknown. METHODS AND RESULTS: The subjects were 36 patients with 36 objective vessels with clinically significant progression of coronary artery disease (>/=15% per year) in whom 4 serial coronary arteriograms (CAGs) were performed at intervals of approximately 4 months in a 1-year period. The degree of progression of percent stenosis between each of 2 serial CAGs was classified as marked (M: >/=15%), slight (S: 5% to 14%), and no progression (N: N-->M in 13 vessels and S-->S-->M in 1 vessel) and 22 type 2 vessels without marked progression (S-->S-->S in 18 vessels, N-->S-->S in 4). Percent stenosis at the first, second, third, and final CAGs was 44+/-14%, 46+/-13%, 46+/-13%, and 88+/-10% (P<0.05 versus first CAG) in type 1 vessels and 44+/-11%, 50+/-9%, 59+/-9%, and 67+/-9% in type 2 vessels (P<0.05 for second, third, and final CAGs versus first CAG). Type 1 vessels featured the sudden appearance of severe stenosis due to marked progression, angina pectoris, or myocardial infarction (71%) and Ambrose type II eccentric lesions indicating plaque rupture or thrombi (57%). Type 2 vessels featured continuous slight progression of stenosis with smooth vessel walls; angina pectoris (14%) occurred when the percent stenosis reached a severe level. An increase in serum C-reactive protein was observed only in the type 2 vessel group, which suggests a relation between continuous slight progression and inflammatory change. CONCLUSIONS: Two types of stenosis progression provide a new insight into the mechanism of coronary artery disease.
Yokoya et al. (Tue,) conducted a observational in Coronary artery disease (n=36). Type 1 marked progression of coronary artery lesions vs. Type 2 continuous slight progression was evaluated on Angina pectoris or myocardial infarction. Type 1 marked progression of coronary lesions was associated with sudden severe stenosis and a high rate of angina or myocardial infarction (71%) compared to Type 2 continuous slight progression (14%).