Clinical study
Association between complex coronary artery stenosis and unstable angina and the extent of plaque inflammation

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Abstract

Purpose

Patients with unstable coronary syndromes often have complex morphology of coronary stenoses at angiography. We evaluated the association between qualitative assessment of coronary stenoses and plaque inflammation determined by immunohistochemistry.

Methods

A total of 79 patients with unstable (n = 46) or stable angina (n = 33) underwent directional coronary atherectomy for culprit lesions. Qualitative analysis of coronary angiograms was performed using a modified Ambrose classification. Coronary lesions were categorized as either simple (concentric and eccentric type I, n = 29) or complex (eccentric type II and multiple irregularities, n = 50). Cryostat sections of retrieved atherosclerotic specimens were stained immunohistochemically with monoclonal antibodies, α-actin (smooth muscle cells), CD68 (macrophages), and CD3 (T lymphocytes). The extent of atherosclerotic inflammation within each coronary lesion was determined by the percentage of immunopositive macrophages per total tissue area (including smooth muscle cells) and the number of T lymphocytes per mm2.

Results

The mean (± SD) percentage of macrophages in atherectomy specimens from patients with unstable angina was greater than in specimens from patients with stable angina (21% ± 14% vs. 13% ± 10%, P = 0.01); similar results were seen when complex coronary lesions were compared with simple lesions (23% ± 13% vs. 9% ± 8%, P <0.001). In multivariate linear regression models, the combination of unstable angina and lesion complexity was strongly associated with the percentage of plaque macrophages.

Conclusion

The extent of atherosclerotic plaque inflammation is associated with angiographic grading of coronary lesion complexity and unstable angina.

Section snippets

Study patients

Directional coronary atherectomy for culprit coronary lesions suitable for coronary atherectomy (in general, proximal and eccentric lesions) was performed in 79 consecutive patients with unstable (Braunwald class I to III, n = 46) (8) or stable (Canadian Cardiovascular Society class I to III, n = 33) (9) angina. The coronary lesion was identified as the “culprit lesion” based on clinical and electrocardiographic findings.

Qualitative and quantitative assessment of coronary stenosis

Qualitative assessment of coronary lesions was performed following the

Results

The mean (± SD) age of the predominantly male (76%) sample was 59 ± 11 years (Table 1).

Discussion

Several mechanical and biological factors affect the clinical presentation of coronary artery disease. Complex coronary lesions are associated with reduced coronary flow and tend to manifest clinically as unstable angina (11). Culprit lesions in patients with unstable angina contain large numbers of macrophages and T lymphocytes compared with those in patients with stable angina 6, 7. These inflammatory cells may cause deleterious effects in the shoulder region of a lipid-rich plaque, the site

Acknowledgements

The authors acknowledge D. Kearney, M. I. Schenker, and W. P. Meun for preparing the manuscript, and the technical and nursing staff of the Cardiac Catheterization Laboratory (M. G. H. Meesterman) for their skilled assistance.

References (16)

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This study was sponsored by the Netherlands Heart Foundation (grants D96.020 and 2000.090).

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