RAPID ANGIOGRAPHIC PROGRESSION OF CORONARY-ARTERY DISEASE IN PATIENTSWITH ANGINA-PECTORIS - THE ROLE OF COMPLEX STENOSIS MORPHOLOGY

Background Rapid disease progression commonly underlies acute coronary events, and ''complex'' stenosis morphology may play a role in this p henomenon. Methods nod Results We studied the role of complex stenosis morphology in rapid disease progression in 94 consecutive patients aw aiting routine coronary angioplasty. Coronary arteriography was repeat ed at 8+/-3 months' follow-up, immediately preceding angioplasty (68 p atients) or after an acute coronary event (26 patients). Disease progr ession of 217 stenoses, of which 79 (36%) were ''complex'' and 138 (64 %) were ''smooth,'' was assessed by computerized angiography. At prese ntation, 63 patients had stable angina pectoris and 31 had unstable an gina that settled rapidly with medical therapy. At follow-up, 23 patie nts (24%) had progression of preexisting stenoses and 71 (76%) had no progression Patients with progression were younger (55+/-12 years) tha n those without (58+/-9 years) but did not differ with regard to risk factors, previous myocardial infarction, or severity and extent of cor onary disease, Twenty-three lesions (11%) progressed, 15 to total occl usion (11 complex and 4 smooth; 65%). Progression occurred in 17 of th e 79 complex stenoses (22%) and in 6 of the 138 smooth lesions (4%) (P =.002). Mean stenosis diameter reduction was also significantly greate r in complex than in smooth lesions (11.6% versus 3.9% change; P<.001) . Acute coronary events occurred in 57% of patients with progression c ompared with 18% of those without progression (P<.001) and were more f requent in patients who presented with unstable angina (P=.002). Concl usions Rapid stenosis progression is not uncommon, and complex stenose s are at risk more than smooth lesions.