Angiographic Stenosis Progression and Coronary Events in Patients With ‘Stabilized’ Unstable Angina

Chen, Lijia; Chester, Michael R.; Redwood, Simon; Huang, Jian; Leatham, E; Kaski, Juan Carlos

doi:10.1161/01.cir.91.9.2319

Cited by 89 publications

(35 citation statements)

References 35 publications

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“…Maehara et al 5 showed that complex lesions represent atherogenic, vulnerable plaques prone to disruption or actually disrupted plaques, a finding that supports our previous observations 1,18,19 and the hypothesis that plaque rupture may be one of the mechanisms leading to crescendo angina and ACS in patients with CSA.…”

Section: Discussionsupporting

confidence: 79%

“…The presence of complex stenoses may have prognostic importance, because these lesions tend to progress faster than smooth uncomplicated coronary stenoses 1,18,19 and may lead to ACS. Maehara et al 5 showed that complex lesions represent atherogenic, vulnerable plaques prone to disruption or actually disrupted plaques, a finding that supports our previous observations 1,18,19 and the hypothesis that plaque rupture may be one of the mechanisms leading to crescendo angina and ACS in patients with CSA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy-Associated Plasma Protein A and Its Endogenous Inhibitor, the Proform of Eosinophil Major Basic Protein (proMBP), Are Related to Complex Stenosis Morphology in Patients With Stable Angina Pectoris

et al. 2004

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Background-The metalloproteinase pregnancy-associated plasma protein-A (PAPP-A) has been implicated in coronary plaque disruption. Its endogenous inhibitor, the proform of eosinophil major basic protein (proMBP), may also play a role in this process. Atheromatous plaque disruption often presents as complex angiographic lesions. We sought to assess whether PAPP-A, proMBP, and PAPP-A/ProMBP ratio are markers of angiographic plaque complexity in patients with chronic stable angina. Methods and Results-We studied 396 stable angina patients (age 63Ϯ10 years, 230 men) of whom 289 had angiographically documented coronary artery disease (Ն75% stenosis). All coronary stenoses Ն30% diameter reduction (n ϭ531 in 322 patients) were assessed and classified as complex (n ϭ228) or smooth (n ϭ303) by previously validated criteria. PAPP-A, proMBP, and C-reactive protein (hs-CRP) serum levels were measured by ELISA. Patients with complex coronary stenoses had a significantly (PϽ0.001) higher PAPP-A/proMBP ratio (3.1Ϯ1.2 versus 2.7Ϯ0.8ϫ10

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Pregnancy-Associated Plasma Protein A and Its Endogenous Inhibitor, the Proform of Eosinophil Major Basic Protein (proMBP), Are Related to Complex Stenosis Morphology in Patients With Stable Angina Pectoris

et al. 2004

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“…It is known that angiographically complex coronary lesions represent either vulnerable plaques prone to disruption or truly disrupted plaques. 14, 18 In fact, the present study demonstrated that G2 plaque neovascularization assessed by CEUS was associated significantly with ACS at hospital admission. Moreover, CEUS-assessed plaque neovascularization significantly correlated with troponin T levels at admission in patients with ACS.…”

Section: Discussionmentioning

confidence: 50%

Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neovascularization Is Useful for Identifying High-Risk Patients With Coronary Artery Disease

Deyama

Nakamura

Takishima

et al. 2013

Circ J

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A previous study indicated that plaque instability is not merely a local vascular occurrence, 11 but rather exists simultaneously at multiple sites in the systemic vascular bed. It is therefore possible that instability of coronary plaque could be assessed by evaluating plaque neovascularization in the carotid arteries. This study therefore examined whether CEUS of the carotid artery provided information on the severity and instability of coronary artery disease (CAD) and also assessed the efficacy of statin treatment in patients with CAD. ncreased neovascularization in atherosclerotic plaque has been shown to be associated with plaque progression and instability, leading to atherosclerotic occlusive cardiovascular events. 1-3 Contrast-enhanced ultrasound (CEUS) is an emerging valuable tool for visualizing plaque neovascularization in the carotid artery, with the properties of contrast agent microbubbles, making them act as pure intravascular tracers. 3-5 CEUS has the advantages of being a simple and minimally invasive in vivo technique. 3-5 The usefulness and reliability of CEUS have been validated by previous studies in animals and humans that showed the degree of plaque neovascularization assessed by CEUS correlated strongly with histological density of neovessels. 6-8 CEUS also showed a greater extent of plaque neovascularization of the carotid artery in symptomatic patients with previous cerebro- Background: Contrast-enhanced ultrasound (CEUS) in the carotid artery has potential as a technique for imaging plaque neovascularization. This study examined whether CEUS could provide information on the severity and instability of coronary artery disease (CAD).

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“…The follow-up period was set at 1 year as most severe complications occur in these patients during the first year [11,12] . Follow-up data were obtained from telephone interviews and from review of the patient's hospital records.…”

Section: Follow-upmentioning

confidence: 99%

“…It is known that the great majority (up to 95%) of patients with unstable angina do not develop myocardial infarction during the short term or the in-hospital period; however, recurrent unstable ischaemic events are common [11,16] . Since different prognoses exist, risk stratification to identify patients at a higher risk of future events is necessary in order to apply the most suitable treatment and management.…”

Section: Dse In Ua 1067mentioning

confidence: 99%

Feasibility and prognostic value of dobutamine–atropine stress echocardiography early in unstable angina

Sitges

Paré

Azqueta

et al. 2000

European Heart Journal

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Background and AimBecause unstable angina has always been considered a contraindication for dobutamineatropine stress echocardiography (DSE), the role of dobutamine-atropine stress echocardiography in unstable angina is unknown. Our aim was to assess the safety and prognostic value of dobutamine-atropine stress echocardiography in unstable angina.Methods One hundred and thirty-two patients were studied (mean age 64 12 years, 29 women). Dobutamineatropine stress echocardiography was performed on the third day after hospital admission. End-points were unstable angina, myocardial infarction or cardiac death at 1 year follow-up. ResultsNo major complications occurred during dobutamine-atropine stress echocardiography. Ninety-six (78%) patients were on beta-blocker therapy during the test; mean maximum heart rate achieved was 106 23 beats . min 1 . Nine of the 21 patients (43%) with a positive dobutamine-atropine stress echocardiography presented cardiac events during follow-up: two patients died, one had a myocardial infarction and six had recurrent class III-IV angina. Among 80 patients with negative dobutamineatropine stress echocardiography, one (1%) had myocardial infarction and six patients (7·5%) had recurrent angina.Event-free survival after 1 year for patients with a negative dobutamine-atropine stress echocardiography for ischaemia was 91% compared to 57% for those with a positive dobutamine-atropine stress echocardiography (P<0·0001). Left ventricular dysfunction (P=0·01), prior myocardial infarction (P=0·03) and a positive dobutamine-atropine stress echocardiography (P=0·004) were independent predictors of cardiac events during follow-up.Conclusions Dobutamine-atropine stress echocardiography is safe in unstable angina if it is performed when patients remain asymptomatic for at least 48 h. A negative dobutamine-atropine stress echocardiogram for ischaemia predicts a good prognosis in medically treated patients with unstable angina and may allow their early discharge from hospital. Good prognostic information was obtained despite the use of beta-blockers and low heart rates during dobutamine-atropine stress echocardiography.

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Angiographic Stenosis Progression and Coronary Events in Patients With ‘Stabilized’ Unstable Angina

Abstract: In unstable angina patients who stabilize medically, subsequent short-term stenosis progression and coronary events are common. The unstable coronary lesion (particularly complex stenoses) is often not stabilized and will continue to progress over the ensuing months.

Cited by 89 publications

References 35 publications

Pregnancy-Associated Plasma Protein A and Its Endogenous Inhibitor, the Proform of Eosinophil Major Basic Protein (proMBP), Are Related to Complex Stenosis Morphology in Patients With Stable Angina Pectoris

Pregnancy-Associated Plasma Protein A and Its Endogenous Inhibitor, the Proform of Eosinophil Major Basic Protein (proMBP), Are Related to Complex Stenosis Morphology in Patients With Stable Angina Pectoris

Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neovascularization Is Useful for Identifying High-Risk Patients With Coronary Artery Disease

Feasibility and prognostic value of dobutamine–atropine stress echocardiography early in unstable angina

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