(Circulation. 1995;92:1408-1413.)
© 1995 American Heart Association, Inc.
Articles |
Ischemia-Related Lesion Characteristics in Patients With Stable or Unstable Angina
A Study With Intracoronary Angioscopy and Ultrasound
From the Thoraxcenter, Erasmus University Rotterdam, the Netherlands.
Correspondence to P.J. de Feyter, MD, Catheterization Laboratory and Intracoronary Imaging Laboratory, Thoraxcenter Bldg 416, University Hospital Dijkzigt, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands.
Background Postmortem-derived findings support the common beliefs that lipid-rich coronary plaques with a thin, fibrous cap are prone to rupture and that rupture and superimposed thrombosis are the primary mechanisms causing acute coronary syndromes. In vivo imaging with intracoronary techniques may disclose differences in the characterization of atherosclerotic plaques in patients with stable or unstable angina and thus may provide clues to which plaques may rupture and whether rupture and thrombosis are active.
Methods and Results We assessed the characteristics of the ischemia-related lesions with coronary angiography and intracoronary angioscopy and determined their compositions with intracoronary ultrasound in 44 patients with unstable and 23 patients with stable angina. The angiographic images were classified as noncomplex (smooth borders) or complex (irregular borders, multiple lesions, thrombus). Angioscopic images were classified as either stable (smooth surface) or thrombotic (red thrombus). The ultrasound characteristics of the lesion were classified as poorly echo-reflective, highly echo-reflective with shadowing, or highly echo-reflective without shadowing. There was a poor correlation between clinical status and angiographic findings. An angiographic complex lesion (n=33) was concordant with unstable angina in 55% (24 of 44); a noncomplex lesion (n=34) was concordant with stable angina in 61% (14 of 23). There was a good correlation between clinical status and angioscopic findings. An angioscopic thrombotic lesion (n=34) was concordant with unstable angina in 68% (30 of 44); a stable lesion (n=33) was concordant with stable angina in 83% (19 of 23). The ultrasound-obtained composition of the plaque was similar in patients with unstable and stable angina.
Conclusions Angiography discriminates poorly between lesions in stable and unstable angina. Angioscopy demonstrated that plaque rupture and thrombosis were present in 17% of stable angina and 68% of unstable angina patients. Currently available ultrasound technology does not discriminate stable from unstable plaques.
Key Words: angina • ultrasonics • angiography
This article has been cited by other articles:
 |
|
 |
|
  H. L. Dauerman Coronary Intervention Without a Safety Net J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1299 - 1301. [Full Text] [PDF]
|
|
|
|
|
|
T. Amano, T. Matsubara, T. Uetani, M. Nanki, N. Marui, M. Kato, K. Arai, K. Yokoi, H. Ando, H. Ishii, et al. Impact of Metabolic Syndrome on Tissue Characteristics of Angiographically Mild to Moderate Coronary Lesions: Integrated Backscatter Intravascular Ultrasound Study J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1149 - 1156. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
|
|
|
|
|
|
M. A.S. Cordeiro and J. A.C. Lima Atherosclerotic plaque characterization by multidetector row computed tomography angiography. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C40 - C47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I.-K. Jang, G. J. Tearney, B. MacNeill, M. Takano, F. Moselewski, N. Iftima, M. Shishkov, S. Houser, H. T. Aretz, E. F. Halpern, et al. In Vivo Characterization of Coronary Atherosclerotic Plaque by Use of Optical Coherence Tomography Circulation, March 29, 2005; 111(12): 1551 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ehara, Y. Kobayashi, M. Yoshiyama, K. Shimada, Y. Shimada, D. Fukuda, Y. Nakamura, H. Yamashita, H. Yamagishi, K. Takeuchi, et al. Spotty Calcification Typifies the Culprit Plaque in Patients With Acute Myocardial Infarction: An Intravascular Ultrasound Study Circulation, November 30, 2004; 110(22): 3424 - 3429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Erbel, A. Schmermund, M. Abedin, Y. Tintut, and L. L. Demer Clinical Significance of Coronary Calcification Arterioscler. Thromb. Vasc. Biol., October 1, 2004; 24(10): e172 - e172. [Full Text] [PDF]
|
|
|
|
|
|
M. Madjid, A. Zarrabi, S. Litovsky, J. T. Willerson, and W. Casscells Finding Vulnerable Atherosclerotic Plaques: Is It Worth the Effort? Arterioscler. Thromb. Vasc. Biol., October 1, 2004; 24(10): 1775 - 1782. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-K. Hong, G. S. Mintz, C. W. Lee, Y.-H. Kim, S.-W. Lee, J.-M. Song, K.-H. Han, D.-H. Kang, J.-K. Song, J.-J. Kim, et al. Comparison of Coronary Plaque Rupture Between Stable Angina and Acute Myocardial Infarction: A Three-Vessel Intravascular Ultrasound Study in 235 Patients Circulation, August 24, 2004; 110(8): 928 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Schaar, E. Regar, F. Mastik, E. P. McFadden, F. Saia, C. Disco, C. L. de Korte, P. J. de Feyter, A. F.W. van der Steen, and P. W. Serruys Incidence of High-Strain Patterns in Human Coronary Arteries: Assessment With Three-Dimensional Intravascular Palpography and Correlation With Clinical Presentation Circulation, June 8, 2004; 109(22): 2716 - 2719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Okamatsu, M. Takano, S. Sakai, F. Ishibashi, R. Uemura, T. Takano, and K. Mizuno Elevated Troponin T Levels and Lesion Characteristics in Non-ST-Elevation Acute Coronary Syndromes Circulation, February 3, 2004; 109(4): 465 - 470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Stone, D. A. Cox, J. Babb, D. Nukta, L. Bilodeau, L. Cannon, T. D. Stuckey, J. Hermiller, E. A. Cohen, R. Low, et al. Prospective, randomized evaluation of thrombectomy prior to percutaneous intervention in diseased saphenous vein grafts and thrombus-containing coronary arteries J. Am. Coll. Cardiol., December 3, 2003; 42(11): 2007 - 2013. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. G. Neri Serneri, M. Boddi, P. A. Modesti, I. Cecioni, M. Coppo, M. L. Papa, T. Toscano, A. Marullo, and M. Chiavarelli Immunomediated and Ischemia-Independent Inflammation of Coronary Microvessels in Unstable Angina Circ. Res., June 27, 2003; 92(12): 1359 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Casscells, M. Naghavi, and J. T. Willerson Vulnerable Atherosclerotic Plaque: A Multifocal Disease Circulation, April 29, 2003; 107(16): 2072 - 2075. [Full Text] [PDF]
|
|
|
|
 |
|
 P J de Feyter and K Nieman New coronary imaging techniques: what to expect? Heart, March 1, 2002; 87(3): 195 - 197. [Full Text] [PDF]
|
|
|
|
|
|
B. Lindahl, E. Diderholm, B. Lagerqvist, P. Venge, L. Wallentin, and the FRISC II Investigators Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: a FRISC II substudy J. Am. Coll. Cardiol., October 1, 2001; 38(4): 979 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Weiss Another Calcium Paradox? Arterioscler. Thromb. Vasc. Biol., October 1, 2001; 21(10): 1561 - 1562. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Badimon, G. Vilahur, S. Sanchez, and X. Duran Atheromatous plaque formation and thrombogenesis: formation, risk factors and therapeutic approaches Eur. Heart J. Suppl., August 1, 2001; 3(suppl_I): I16 - I22. [Abstract] [PDF]
|
|
|
|
|
|
M. Asakura, Y. Ueda, O. Yamaguchi, T. Adachi, A. Hirayama, M. Hori, and K. Kodama Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1284 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nakamura, H. Nishikawa, S. Mukai, M. Setsuda, K. Nakajima, H. Tamada, H. Suzuki, T. Ohnishi, Y. Kakuta, T. Nakano, et al. Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study J. Am. Coll. Cardiol., January 1, 2001; 37(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Wexberg, M. Gyongyosi, W. Sperker, K. Kiss, P. Yang, A. Hassan, G. Pasterkamp, and D. Glogar Pre-existing arterial remodeling is associated with in-hospital and late adverse cardiac events after coronary interventions in patients with stable angina pectoris J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1860 - 1869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. S. Van de Water, J. K. French, M. Lund, T. A. Hyde, H. D. White, and P. J. Browett Prevalence of factor v leiden and prothrombin variant g20210a in patients age <50 years with no significant stenoses at angiography three to four weeks after myocardial infarction J. Am. Coll. Cardiol., September 1, 2000; 36(3): 717 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Virmani, F. D. Kolodgie, A. P. Burke, A. Farb, and S. M. Schwartz Lessons From Sudden Coronary Death : A Comprehensive Morphological Classification Scheme for Atherosclerotic Lesions Arterioscler. Thromb. Vasc. Biol., May 1, 2000; 20(5): 1262 - 1275. [Full Text] [PDF]
|
|
|
|
|
|
M. Marzilli, G. Sambuceti, S. Fedele, and A. L'Abbate Coronary microcirculatory vasoconstriction during ischemia in patients with unstable angina J. Am. Coll. Cardiol., February 1, 2000; 35(2): 327 - 334. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Gyongyosi, P Yang, A Hassan, F Weidinger, H Domanovits, A Laggner, and D Glogar Arterial remodelling of native human coronary arteries in patients with unstable angina pectoris: a prospective intravascular ultrasound study Heart, July 1, 1999; 82(1): 68 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Stefanadis, L. Diamantopoulos, C. Vlachopoulos, E. Tsiamis, J. Dernellis, K. Toutouzas, E. Stefanadi, and P. Toutouzas Thermal Heterogeneity Within Human Atherosclerotic Coronary Arteries Detected In Vivo : A New Method of Detection by Application of a Special Thermography Catheter Circulation, April 20, 1999; 99(15): 1965 - 1971. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Rabbani and E. J. Topol Strategies to achieve coronary arterial plaque stabilization Cardiovasc Res, February 1, 1999; 41(2): 402 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C Smits, G. Pasterkamp, P. P.T de Jaegere, P. J de Feyter, and C. Borst Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study Cardiovasc Res, February 1, 1999; 41(2): 458 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Smalling and H. V. Anderson Pathophysiological Insight Into the Possible Optimal Therapies for Acute Myocardial Infarction and Unstable Angina Circulation, January 13, 1998; 97(1): 10 - 11. [Full Text] [PDF]
|
|
|
|
|
|
H. Toss, B. Lindahl, A. Siegbahn, L. Wallentin, and f. t. F. S. Group Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease Circulation, December 16, 1997; 96(12): 4204 - 4210. [Abstract] [Full Text]
|
|
|
|
|
|
K. G. Lehmann, R. J. van Suylen, J. Stibbe, C. J. Slager, J. A. Oomen, A. Maas, C. di Mario, P. deFeyter, and P. W. Serruys Composition of Human Thrombus Assessed by Quantitative Colorimetric Angioscopic Analysis Circulation, November 4, 1997; 96(9): 3030 - 3041. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Ozaki, A. G. Violaris, T. Kobayashi, D. Keane, E. Camenzind, C. Di Mario, P. de Feyter, J. R. T. C. Roelandt, and P. W. Serruys Comparison of Coronary Luminal Quantification Obtained From Intracoronary Ultrasound and Both Geometric and Videodensitometric Quantitative Angiography Before and After Balloon Angioplasty and Directional Atherectomy Circulation, July 15, 1997; 96(2): 491 - 499. [Abstract] [Full Text]
|
|
|
|
|
|
Y.-H. Chen, Y.-L. Chen, S.-J. Lin, C.-Y. Chou, G.-Y. Mar, M.-S. Chang, and S.-P. Wang Electron Microscopic Studies of Phenotypic Modulation of Smooth Muscle Cells in Coronary Arteries of Patients With Unstable Angina Pectoris and Postangioplasty Restenosis Circulation, March 4, 1997; 95(5): 1169 - 1175. [Abstract] [Full Text]
|
|
|
|
|
|
A. P. Burke, A. Farb, Y.-h. Liang, J. Smialek, and R. Virmani Effect of Hypertension and Cardiac Hypertrophy on Coronary Artery Morphology in Sudden Cardiac Death Circulation, December 15, 1996; 94(12): 3138 - 3145. [Abstract] [Full Text]
|
|