Correlation of Angiographic Morphology and Clinical Presentation in Unstable Angina

Abstract

Recent rest pain and refractory or postinfarction UA, or both, are strongly associated with the general category of complex lesions and specifically with angiographically detected ICT and decreased TIMI flow.

Elevated Plasma Levels of Oxidized Low-Density Lipoprotein Relate to the Presence of Angiographically Detected Complex and Thrombotic Coronary Artery Lesion Morphology in Patients With Unstable Angina

“…In our analysis, total occlusions and intracoronary thrombus were considered complex lesions, and were not classified as separate angiographic variables. 18 The interobserver agreement for angiographic morphology was 90% and the intraobserver agreement was 93%.…”

“…13,17,18 In the present study, we incorporated complex morphology, intracoronary thrombus and total occlusions into the general angiographic definition of a complex lesion, as previously described by Dangas et al 18 A number of previous angiographic studies have reported that complex and thrombotic lesions are prevalent in UAP. 13,[15][16][17][18] Pathological studies of postmortem material revealed that these angiographic appearances were caused by plaque disruption with thrombosis. 14 Moreover, a recent immunohistochemical study using atherectomy specimens demonstrated that in UAP patients specimens from angiographic complex lesions had a greater percentage of macrophages than those from angiographic simple lesions.…”

“…17,18 Dangas et al found that the incidence of angiographically detected complex and thrombotic lesions was higher in Braunwald class III than in class I. 18 Rupprecht et al also reported that the incidence of angiographic evidence of complex lesions and/or thrombosis rose progressively with higher UAP class. 17 These observations clearly indicate an association between high Braunwald score and the incidence of angiographic findings of complex and thrombotic lesions.…”

“…18 We excluded patients with variant angina, concomitant inflammatory diseases or malignant tumors, and those undergoing dialysis. Variant angina was defined as recurrent attacks of chest symptoms occurring spontaneously at rest, with ST-segment elevation on the ECG, which were rapidly relieved by nitroglycerin.…”

“…[13][14][15][16] Previous clinical studies have also revealed that angiographically detected complex lesions correlated with higher Braunwald class. 17,18 However, it has also been shown that patients with Braunwald class I occasionally show angiographic evidence of a complex lesion. 17,18 Hence, given the role of ox-LDL in plaque instability in Hiroyuki Itabe, PhD † ; Toru Kataoka, MD; Yoshiki Kobayashi, MD; Anton E. Becker, MD ‡ ; Junichi Yoshikawa, MD † † ; Makiko Ueda, MD** Background Increased levels of oxidized low-density lipoprotein (ox-LDL) are related to plaque instability, so the aim of the present study was to investigate whether there is a relationship between angiographic coronary plaque morphology in patients with unstable angina pectoris (UAP) and the level of ox-LDL.…”