CORONARY STENOSIS PROGRESSION DIFFERS IN PATIENTS WITH STABLE ANGINA-PECTORIS WITH AND WITHOUT A PREVIOUS HISTORY OF UNSTABLE ANGINA

Objectives To compare the evolution of stenoses responsible for acute coronary events with those not associated with acute coronary syndrome s. Methods and results We prospectively studied angiographic stenosis progression in 190 stable angina patients, with single vessel disease, who were awaiting non-urgent coronary angioplasty. Sixty four patient s had a previous history of unstable angina (Group 1) and 126 patients had no history of unstable angina (Group 2). Culprit stenoses were cl assified as 'complex' or 'smooth', At restudy, 8+/-4 months after the first angiogram, 12 of 63 culprit stenoses in Group 1 had progressed a nd seven of 125 in Group 2 (19% vs 6%, P=0 . 004). Thirteen of 68 comp lex culprit stenoses had progressed, compared with only 6 of 120 smoot h culprit stenoses (19% vs 5%, P=0 . 003). Coronary events occurred in 12 Group 1 patients and nine Group 2 patients (P=0 . 02). Conclusions In patients with stable angina, stenoses associated with previous epi sodes of unstable angina are more likely to progress than stenoses not associated with previous unstable angina. Unstable coronary atheroscl erotic plaques, even those that have been clinically stable for more t han 3 months, may retain the potential for rapid progression to total occlusion.