LIMITATIONS OF ANGIOGRAPHY FOR ANALYZING CORONARY ATHEROSCLEROSIS PROGRESSION OR REGRESSION

Purpose: To analyze the utility and limitations of serial coronary ang iography for determining atherosclerosis progression and regression. D ata Sources: A MEDLINE search of the English-language literature (1966 to January 1994) using the keywords atherosclerosis regression, ather osclerosis progression, lipid reduction therapy, and coronary angiogra phy. Study Selection: Selected articles on the effects of cholesterol reduction and lifestyle modification on angiographic coronary artery d isease, on the animal models of atherosclerosis progression and regres sion, and on the limitations of coronary angiography. Data Extraction: Independent extraction by two authors. Results: Although several stud ies have reported that the rate of atherosclerosis progression, define d by serial coronary angiography, can be reduced and that luminal diam eter can be improved somewhat by aggressive lipid modification, the re ported changes are small (0.3 mm or 10% change) and have required a pr olonged study duration (range, 1 to 10 years). More importantly, angio graphy simply does not measure atherosclerosis and cannot assess lesio n composition. Angiography also underestimates the extent of atheroscl erosis, especially in angiographically normal segments. In addition, d ifficulties with data acquisition, such as substantial variabilities i n serial measurements of percent diameter stenosis and minimal luminal diameters, require large sample sizes to show statistically significa nt regression, even with computerized quantification. Conclusions: Giv en its current limitations, serial coronary angiography is not a satis factory means of detecting atherosclerosis progression or regression.