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CLINICAL STUDY

Recurrent unstable angina after directional coronary atherectomy is related to the extent of initial coronary plaque inflammation

Martijn Meuwissen, MD^*, Jan J. Piek, MD^*,1, Allard C. van der Wal, MD, Steven A. J. Chamuleau, MD^*, Karel T. Koch, MD^*, Peter Teeling, RT, Chris M. van der Loos, PhD, Jan G. P. Tijssen, PhD^* and Anton E. Becker, MD, FACC

^* Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Manuscript received July 10, 2000; revised manuscript received November 14, 2000, accepted December 15, 2000.

Reprint requests and correspondence: Dr. Jan J. Piek, Department of Cardiology, B2-108, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
m.meuwissen{at}amc.uva.nl

OBJECTIVES

This study was performed to evaluate the relationship between plaque inflammation of the initial culprit lesion and the incidence of recurrent angina for one year after directional coronary atherectomy (DCA).

BACKGROUND

A positive correlation between coronary plaque inflammation and angiographic restenosis has been reported.

METHODS

A total of 110 patients underwent DCA. Cryostat sections were immunohistochemically stained with monoclonal antibodies CD68 (macrophages), CD-3 (T lymphocytes) and alpha-actin (smooth muscle cells [SMCs]). The SMC and macrophage contents were planimetrically quantified as a percentage of the total tissue area. T lymphocytes were counted as the number of cells/mm². The patients were followed for one year to document recurrent unstable angina pectoris (UAP) or stable angina pectoris (SAP).

RESULTS

Recurrent UAP developed in 16 patients, whereas recurrent SAP developed in 17 patients. The percent macrophage areas were larger in patients with recurrent UAP (27 ± 12%) than in patients with recurrent SAP (8 ± 4%; p = 0.0001) and those without recurrent angina (18 ± 14%; p = 0.03). The number of T lymphocytes was also greater in patients with recurrent UAP (25 ± 14 cells/mm²) than in patients with recurrent SAP (14 ± 8 cells/mm²; p = 0.02) and those without recurrent angina (14 ± 12 cells/mm²; p = 0.002). Multiple stepwise logistic regression analysis identified macrophage areas and T lymphocytes as independent predictors for recurrent UAP.

CONCLUSIONS

There is a positive association between the extent of initial coronary plaque inflammation and the recurrence of unstable angina during long-term follow-up after DCA. These results underline the role of ongoing smoldering plaque inflammation in the recurrence of unstable angina after coronary interventions.

Abbreviations and Acronyms   CCS = Canadian Cardiovascular Society   DCA = directional coronary atherectomy   DS = diameter stenosis   MLD = minimal lumen diameter   QCA = quantitative coronary angiography   RD = reference diameter   SAP = stable angina pectoris   SMC = smooth muscle cell   UAP = unstable angina pectoris

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