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J Am Coll Cardiol, 2001; 37:63-69
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study

Mamoo Nakamura, MD*, Hideo Nishikawa, MD*, Sei Mukai, MD*, Morimichi Setsuda, MD*, Kazuki Nakajima, MD*, Hiroya Tamada, MD*, Hiroyuki Suzuki, MD*, Takahiro Ohnishi, MD*, Yutaka Kakuta, MD*, Takeshi Nakano, MD{dagger} and Alan C. Yeung, MD, FACC{ddagger}

* Division of Cardiology, Yamada Red Cross Hospital, Watara, Japan
{dagger} First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan
{ddagger} Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA

Manuscript received October 18, 1999; revised manuscript received August 16, 2000, accepted September 28, 2000.

Reprint requests and correspondence: Dr. Hideo Nishikawa, Division of Cardiology, Yamada Red Cross Hospital, 810 Takabuku, Misono, Watarai, Mie 516-0805, Japan

OBJECTIVES

We examined the association between the features of the culprit lesion in coronary artery disease (CAD) and clinical presentation as shown by intravascular ultrasound (IVUS).

BACKGROUND

The association between coronary remodeling pattern and clinical presentation of CAD is unclear.

METHODS

We analyzed 125 selected patients who underwent preintervention IVUS. Acute myocardial infarction (AMI) and unstable angina pectoris (UAP) were categorized as an acute coronary syndrome (ACS), and stable angina pectoris (SAP) and old myocardial infarction (OMI) as stable CAD. Coronary remodeling patterns and plaque morphology of the culprit lesion obtained by IVUS were analyzed in terms of their association with clinical presentation or angiographic morphology.

RESULTS

Angiographically complex lesions were associated with ACS and OMI. In patients with a complex lesion, positive remodeling was observed more frequently than in those with a simple lesion. In AMI and UAP, positive remodeling was observed more frequently than in SAP and OMI (82% vs. 78% vs. 33% vs. 40%, respectively, p < 0.0001). The remodeling ratio was greater in AMI and UAP than in SAP and OMI (1.26 ± 0.15 vs. 1.11 ± 0.10 vs. 0.94 ± 0.11 vs. 0.96 ± 0.13, respectively, p < 0.0001). Furthermore, within ACS, the remodeling ratio was greater in AMI than in UAP (1.26 ± 0.15 vs. 1.11 ± 0.10, respectively, p < 0.05), whereas the frequency of positive remodeling was not different.

CONCLUSIONS

Positive remodeling was more frequently observed in ACS than in stable CAD. Moreover, the degree of positive remodeling was greater in AMI than in UAP. These results may reflect the impact of remodeling types and its degree in the culprit lesion of CAD on clinical presentation.

Abbreviations and Acronyms
  ACS = acute coronary syndrome
  AMI = acute myocardial infarction
  CAD = coronary artery disease
  IVUS = intravascular ultrasound
  LA = lumen area
  OMI = old myocardial infarction
  PA = plaque area
  SAP = stable angina pectoris
  UAP = unstable angina pectoris
  VA = vessel area




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