Coronary artery disease: arterial remodelling and clinical presentation

Objective-To investigate the hypothesis that in coronary artery disease lar ge plaques in compensatorily enlarged segments are associated with acute co ronary syndromes, whereas smaller plaques in shrunken segments are associat ed with stable angina pectoris. Methods-Patients selected for percutaneous transluminal coronary angioplast y (PTCA) were divided into two groups, one with stable angina pectoris (sta ble group, n = 37) and one with unstable angina or postmyocardial infarctio n angina of the infarct related artery (unstable group, n = 32). In both gr oups, remodelling at the culprit lesion site was determined by intravascula r ultrasound before the intervention. Remodelling was calculated as relativ e vessel area: [vessel area culprit lesion site / mean vessel area of both proximal and distal reference sites] x 100%. Compensatory enlargement was d efined as remodelling of greater than or equal to 105%, whereas shrinkage w as defined as remodelling of less than or equal to 95%. Results-In the unstable group, the vessel area at the culprit lesion site w as larger than in the stable group, at mean (SD) 18.1 (5.3) upsilon 14.6 (5 .4) mm(2) (p = 0.008). Lumen areas were similar. Consequently, plaque area and percentage remodelling were larger in the unstable group than in the st able group: mean (SD) 14.8 (4.8) a, 11.6 (4.9) mm(2) (p = 0.009) and 112 (3 1)% upsilon 95 (17)% (p = 0.005), respectively. Significantly more culprit lesion sites were classified as shrunken in the stable group (211 37) than in the unstable group (8/32; p = 0.014). On the other hand, more lesion sit es were classified as enlarged in the unstable group (16/23) than in the st able group (8/37; p = 0.022). Conclusions-In patients selected for PTCA, the mode of remodelling is relat ed to clinical presentation.