Chest

Chest

Volume 94, Issue 4, October 1988, Pages 731-736
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Development of Significant Coronary Artery Lesions in Areas of Minimal Disease: A Common Mechanism for Coronary Disease Progression

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In 62 patients with coronary disease who had serial arteriograms without intervening coronary artery bypass graft (CABG) or percutaneous transluminal coronary arteriography (PTCA), progression was seen in 48 (77 percent). Progression from a normal or minimally narrowed lumen diameter to narrowing ≥75 percent (to ≥90 percent) in 21 patients) occurred in at least one vessel in 33 patients (69 percent) (group A, type I progression). Less striking progression and progression of initially more severe lesions was seen in 15 of 29 patients without type 1 progression (Group B) and in other vessels in 12 group A patients. Improvement in at least one vessel was seen in eight patients. There was no difference between groups A and B in the incidence of risk factors, intervening myocardial infarction, or recent unstable angina. It is concluded that progression of occlusive coronary disease occurs as commonly in areas of the coronary tree that are minimally diseased as in segments that are initially severely narrowed. Methods to stabilize the endothelium may prevent progression of coronary artery disease. (Chest 1988; 94:731-36)

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MATERIAL AND METHODS

Patients were studied who had significant coronary artery disease (at least one vessel with > 50 percent lumen diameter obstruction) during coronary arteriography performed between Jan 1, 1985, and March 31, 1987, who had had a previous arteriogram, and who had not had CABG surgery or PTCA performed between the procedures. The clinical indication for the initial coronary arteriogram was chest pain. Repeated arteriography was performed because of recurrence, persistence, or increase in chest

RESULTS

Sixty-two patients were included in the study (Table 1). Thirty-three patients (25 men and 8 women, group A) had lesions that fulfilled the characteristics of type 1 progression, and 29 patients (25 men and 4 women, group B) had no lesions with type 1 progression. The mean age of group A patients was 56.0 ± 7.9 years and of group B was 58.4 ± 8.2 (NS). The mean time between the initial and subsequent angiograms was 53.3 ± 31.8 months for group A and 33.9 ± 27.0 months for group B (p<.01).

DISCUSSION

It has been postulated8 and fairly widely accepted that a coronary atherosclerotic lesion or plaque gradually increases in size, encroaching on the lumen of the coronary artery until flow is sufficiently obstructed to cause angina. When the narrowing becomes sufficiently severe, a clot may obstruct the remaining orifice, and myocardial infarction occurs. In this study we had expected to see areas of significant coronary narrowing to become more severe or to have gone on to total occlusion and

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Manuscript received November 30; revision accepted March 8.

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Copyright © 1988 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.