Angiographic evolution of coronary artery morphology in unstable angina

John A. Ambrose, Stephen Winters, Rohit R. Arora, Angie Eng, Albert Riccio, Richard Gorlin, Valentin Fuster

Research output: Contribution to journalArticle

335 Citations (Scopus)

Abstract

As previously reported in acute presentations of unstable angina, an identifiable characteristic coronary artery lesion has been found in about 70% of cases at coronary arteriography. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. To study the evolution of lesions responsible for unstable angina, coronary artery anatomy and morphology on angiography were evaluated in patients with stable angina progressing to unstable angina, Group I comprised 25 patients with a history of stable angina who were restudied after an acute episode of unstable angina and Group II comprised 21 patients with little or no change in symptoms between catheterizations. Progression of coronary disease occurred in 19 (76%) of 25 patients in Group I compared with 7 (33%) of 21 in Group II (p < 0.001). Of the 25 lesions with progression in Group I, 17 progressed to less than 100% and 8 to 100% occlusion. Eighteen of these 25 lesions in Group I were previously insignificant (< 50% occlusion on the first catheterization). In contrast, of the eight lesions with disease progression in Group II, only two were previously insignificant while six showed at least 50% occlusion on the initial study. The eccentric lesion was seen in 71% of all lesions with progression to'less than 100% occlusion in Group 1, but it was not seen in any Group II vessel with progression. Therefore, progression of disease is very common in acute presentations of unstable angina and most lesions progress from previously insignificant stenoses. An eccentric lesion with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both, is the most common configuration of coronary lesions in this type of progression and it appears to be a major cause of unstable angina.

Original languageEnglish (US)
Pages (from-to)472-478
Number of pages7
JournalJournal of the American College of Cardiology
Volume7
Issue number3
DOIs
StatePublished - Jan 1 1986
Externally publishedYes

Fingerprint

Unstable Angina
Coronary Vessels
Stable Angina
Catheterization
Disease Progression
Angiography
Pathologic Constriction
Neck
Coronary Disease
Anatomy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ambrose, John A. ; Winters, Stephen ; Arora, Rohit R. ; Eng, Angie ; Riccio, Albert ; Gorlin, Richard ; Fuster, Valentin. / Angiographic evolution of coronary artery morphology in unstable angina. In: Journal of the American College of Cardiology. 1986 ; Vol. 7, No. 3. pp. 472-478.
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title = "Angiographic evolution of coronary artery morphology in unstable angina",
abstract = "As previously reported in acute presentations of unstable angina, an identifiable characteristic coronary artery lesion has been found in about 70{\%} of cases at coronary arteriography. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. To study the evolution of lesions responsible for unstable angina, coronary artery anatomy and morphology on angiography were evaluated in patients with stable angina progressing to unstable angina, Group I comprised 25 patients with a history of stable angina who were restudied after an acute episode of unstable angina and Group II comprised 21 patients with little or no change in symptoms between catheterizations. Progression of coronary disease occurred in 19 (76{\%}) of 25 patients in Group I compared with 7 (33{\%}) of 21 in Group II (p < 0.001). Of the 25 lesions with progression in Group I, 17 progressed to less than 100{\%} and 8 to 100{\%} occlusion. Eighteen of these 25 lesions in Group I were previously insignificant (< 50{\%} occlusion on the first catheterization). In contrast, of the eight lesions with disease progression in Group II, only two were previously insignificant while six showed at least 50{\%} occlusion on the initial study. The eccentric lesion was seen in 71{\%} of all lesions with progression to'less than 100{\%} occlusion in Group 1, but it was not seen in any Group II vessel with progression. Therefore, progression of disease is very common in acute presentations of unstable angina and most lesions progress from previously insignificant stenoses. An eccentric lesion with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both, is the most common configuration of coronary lesions in this type of progression and it appears to be a major cause of unstable angina.",
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Angiographic evolution of coronary artery morphology in unstable angina. / Ambrose, John A.; Winters, Stephen; Arora, Rohit R.; Eng, Angie; Riccio, Albert; Gorlin, Richard; Fuster, Valentin.

In: Journal of the American College of Cardiology, Vol. 7, No. 3, 01.01.1986, p. 472-478.

Research output: Contribution to journalArticle

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N2 - As previously reported in acute presentations of unstable angina, an identifiable characteristic coronary artery lesion has been found in about 70% of cases at coronary arteriography. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. To study the evolution of lesions responsible for unstable angina, coronary artery anatomy and morphology on angiography were evaluated in patients with stable angina progressing to unstable angina, Group I comprised 25 patients with a history of stable angina who were restudied after an acute episode of unstable angina and Group II comprised 21 patients with little or no change in symptoms between catheterizations. Progression of coronary disease occurred in 19 (76%) of 25 patients in Group I compared with 7 (33%) of 21 in Group II (p < 0.001). Of the 25 lesions with progression in Group I, 17 progressed to less than 100% and 8 to 100% occlusion. Eighteen of these 25 lesions in Group I were previously insignificant (< 50% occlusion on the first catheterization). In contrast, of the eight lesions with disease progression in Group II, only two were previously insignificant while six showed at least 50% occlusion on the initial study. The eccentric lesion was seen in 71% of all lesions with progression to'less than 100% occlusion in Group 1, but it was not seen in any Group II vessel with progression. Therefore, progression of disease is very common in acute presentations of unstable angina and most lesions progress from previously insignificant stenoses. An eccentric lesion with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both, is the most common configuration of coronary lesions in this type of progression and it appears to be a major cause of unstable angina.

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