Abstract
Little information is available regarding the in vivo composition of angina producing culprit atherosclerotic lesions in various anginal syndromes. In this study we used intracoronary ultrasound to determine the composition of culprit lesions in various subsets of anginal syndromes and correlated this composition with the patient's clinical presentation. One hundred and forty six patients referred for angioplasty or atherectomy were classified as having either chronic stable angina (angina which was clinically unchanged for >2 months), crescendo angina (an accelerating pattern of frequent or prolonged anginal episodes), severe rest angina (abrupt onset of prolonged angina) or post-infarction angina (angina within 2 weeks of acute myocardial infarction). Intracoronary ultrasound imaging of the culprit lesion was performed before intervention. Lesions were classified as soft, mixed fibrous without calcium, mixed fibrous with calcium or calcified. Analysis of the ultrasound images revealed that the majority of culprit lesions were soft in severe rest (71%) and post-infarction angina (73%) whereas, the majority of culprit lesions were mixed fibrous or calcified in chronic stable (69%) and crescendo (53%) angina (X2=22.73, p= 0.007). In addition, the frequency of intralesional calcium in chronic stable or crescendo angina was significantly higher than that in severe rest or stable angina. We conclude that the composition of culprit lesions in various anginal subsets are different. The lesion morphology in crescendo angina frequently resembles that in chronic stable angina; while those in severe rest and post-infarction angina are frequently similar. These findings may have implications for medical or interventional treatment of patients with angina.
Similar content being viewed by others
References
Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham Study. Am J Cardiol 1972; 29: 154–63.
Conti CR, Brawley RK, Griffith LSC, et al. Unstable angina pectoris: Morbidity and mortality in 57 consecutive patients evaluated angiographically. Am J Cardiol 1973; 32: 745–50.
Cairnes JA, Fantus JG, Klassen GA. Unstable angina pectoris. Am Heart J 1976; 92: 373–86.
Scanion PJ. The intermediate coronary syndrome. Prog Cardiovasc Dis 1981; 23: 351–68.
Hodgson JMcB, Graham SP, Sheehan H, Savakus AD. Percutaneous intracoronary ultrasound imaging: Initial applications in patients. Echocardiography 1990; 7: 403–13.
Nissen SE, Grines CL, Sublett K, Haynie D, Diaz C, Booth DC, DeMaria AN. Application of a new phased-array ultrasound imaging catheter in the assessment of vascular dimensions. In vivo comparison to cineangiography. Circulation 1990; 81: 660–6.
Cacchione JG, Reddy KG, Richards F, Sheehan H, Hodgson JMcB. Combined intravascularultrasound/angioplasty balloon catheter: Initial use during PTCA. Cath Cardiovascular Diag 1991:24: 99–101.
Hodgson JMcB, Graham SP, Sheehan H, Brands D. Percutaneous intravascular ultrasound imaging: Validation of a real time synthetic aperture array catheter. Am J Card Imag 1991; 5: 65–71.
Hodgson JMcB, Reddy KG, Suneja R, Nair RN, Lesnefsky EJ, Sheehan HM. Intracoronary ultrasound imaging: Correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty. J Am Coll Cardiol 1993; 21: 35–44.
Bartorelli AL, Potkin BN, Almagor Y, Keren G, Roberts WC, Leon MB. Plaque characterization of atherosclerotic coronary arteries by intravascular ultrasound. Echocardiography 1990; 7: 389–95.
De Lezo JS, Romero M, Medina A, Pan M, Pavlovic D, Vaamonde R, Hernandez E, Melian F, Rubio FL, Marrero J, Segura J, Irurita M, Cabrera JA. Intracoronary ultrasound assessment of directional coronary atherectomy: Immediate and follow-up findings. J Am Coll Cardiol 1993; 21: 298–307.
Rasheed Q, Dhawale PJ, Anderson J, Hodgson JMcB. Intracoronary ultrasound defined plaque composition: Computer aided plaque characterization and correlation with histologicsamples obtained during directional coronary atherectomy. Am Heart J 1995 (In press).
Davis MJ. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 1990; 82 (Suppl II): II-38–II-46.
Fuster V, Steele PM, Chesebro JH. Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. J Am Coll Cardiol 1985; 5: 175B-84B.
Fuster V, Stein B, Ambrose JA, Badimon L, Badimon JJ, Chesebro JH. Atherosclerotic plaque rupture and thrombosis. Evolving concepts. Circulation 1990; 82 (Suppl II): II-47–II-59.
Ahmad WH, Bittl JA, Braunwald E. Relation between clinical presentation and angiographic findins in unstable angina pectoris, and comparison with that in stable angina. Am J Cardiol 1993;72: 544–50.
Braunwald E. Unstable angina. A classification. Circulation 1989;80: 410–14.
Ambrose JA, Winters SL, Stern A, Eng A, Tiechholz LE, Gorlin R, Fuster V. Angiographic morphology and pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985; 5: 609–16.
Hangartner JRW, Charleston AJ, Davies MJ, Thomas AC. Morphological characteristics of clinically significant coronary artery stenosis in stable angina. Br Heart J 1986; 56: 501–08.
Williams DO, Topol EJ, Califf RM, Roberts R, Mancini J, Joelson JM, Ellis SG, Kleiman NS. Intravenous recombinant tissue-type plasminogen activator in patients with unstable angina pectoris. Results of a placebo-controlled, randomized trial. Circulation 1990; 82: 376–83.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rasheed, Q., Nair, R.N., Sheehan, H.M. et al. Coronary artery plaque morphology in stable angina and subsets of unstable angina: an in vivo intracoronary ultrasound study. Int J Cardiac Imag 11, 89–95 (1995). https://doi.org/10.1007/BF01844706
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01844706