Abstract 16146: The Presence of a Coronary Obstruction Influences the Natural History of an Adjacent Downstream Obstruction
Background: Atherosclerotic lesions progress in an independent manner. However, the effect of an atherosclerotic obstruction (Ob) on the natural history of an adjacent downstream Ob is unknown. We investigated the hypothesis that an Ob influences the progression of a downstream Ob in human coronary arteries.
Methods: 3D coronary artery reconstruction by angiography & intravascular ultrasound was performed in 374 pts at baseline (BL) and 6-10 months later (FU) to assess plaque natural history. Coronary arteries were divided into consecutive 3mm segments for serial analysis. We identified discrete Obs at BL defined as 3 segments with a throat in the middle [lumen area (LA) difference >5% than the adjacent upstream and downstream segments]. These Obs were further classified according to the presence of an adjacent upstream Ob. Plaque progression was assessed by the change in plaque burden (PB) between BL and FU.
Results: 95 Obs (PB at the throat; 51.1±13.6%) were found to have an adjacent upstream Ob (PB at the throat; 53.7±11.6%), whereas there were 395 Obs (PB at the throat; 49.3±13.4%) without an adjacent Ob. In 38% of cases the distance between the upstream and downstream throats was 9 mm, in 28% 12 mm and in 34% 15 mm. There was a negative relationship between PB change in the 95 downstream Obs and the inter-throat distance (p=0.059; Figure). Obs with an adjacent Ob at an inter-throat distance of 9 mm showed significant increase in PB compared to Obs without an adjacent Ob (p=0.019; Figure). In multivariable analysis, the presence of an upstream Ob (p=0.018) and BL plaque area at the throat of a downstream Ob (p=0.057) were independent predictors of plaque progression in the 95 downstream Obs.
Conclusions: The presence of an adjacent upstream Ob is independently associated with plaque progression at an adjacent downstream Ob, if the distance between these Obs is ≤ 9mm. These findings may have implications for the optimal individualized management of coronary lesions.
- Intravascular ultrasound/Doppler
- Coronary artery disease
- Cardiovascular imaging
- © 2012 by American Heart Association, Inc.