Angiographic morphology and the pathogenesis of unstable angina pectoris

In 110 patients with either stable or unstable angina, the morphology of coronary artery lesions was qualitatively assessed at angiography. Each obstruction reducing the luminal diameter of the vessel by 50% or greater was categorized into one of the following morphologic groups: concentric (symmetric narrowing); type I eccentric (asymmetric narrowing with smooth borders and a broad neck); type II eccentric (asymmetric with a narrow neck or irregular borders, or both); and multiple irregular coronary narrowings in series. For the entire group, type II eccentric lesions were significantly more frequent in the 63 patients with unstable angina (p less than 0.001), whereas concentric and type I eccentric lesions were seen more frequently in the 47 patients with stable angina (p less than 0.05). Type II eccentric lesions were also present in 29 of 41 arteries in patients with unstable angina compared with 4 of 25 arteries in those with stable angina (p less than 0.0001) in whom an "angina-producing" artery could be identified. Therefore, type II eccentric lesions are frequent in patients with unstable angina and probably represent ruptured atherosclerotic plaques or partially occlusive thrombi, or both. A temporary decrease in coronary perfusion secondary to these plaques with or without superimposed transient platelet thrombi or altered vasomotor tone may be responsible for chest pain in some of these patients with unstable angina.

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				B. H. Annex, S. M. Denning, K. M. Channon, M. H. Sketch Jr, R. S. Stack, J. H. Morrissey, and K. G. Peters Differential Expression of Tissue Factor Protein in Directional Atherectomy Specimens From Patients With Stable and Unstable Coronary Syndromes Circulation, February 1, 1995; 91(3): 619 - 622. [Abstract] [Full Text]

				J. F. Mitchel, D. B. Fram, D. F. Palme II, R. Foster, J. A. Hirst, M. A. Azrin, L. M. Bow, A. M. Eldin, D. D. Waters, and R. G. McKay Enhanced Intracoronary Thrombolysis With Urokinase Using a Novel, Local Drug Delivery System : In Vitro, In Vivo, and Clinical Studies Circulation, February 1, 1995; 91(3): 785 - 793. [Abstract] [Full Text]

				P. W. Serruys, P. de Jaegere, F. Kiemeneij, C. Macaya, W. Rutsch, G. Heyndrickx, H. Emanuelsson, J. Marco, V. Legrand, P. Materne, et al. A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease N. Engl. J. Med., August 25, 1994; 331(8): 489 - 495. [Abstract] [Full Text]

				K. Mizuno, A. Miyamoto, K. Isojima, A. Kurita, A. Senoo, T. Arai, M. Kikuchi, and H. Nakamura A Serial Observation of Coronary Thrombi in Vivo by a New Percutaneous Transluminal Coronary Angioscope Angiology, February 1, 1992; 43(2): 91 - 99. [Abstract] [PDF]

				D. R. Holmes Jr and R. E. Vlietstra Balloon Angioplasty in Acute and Chronic Coronary Artery Disease JAMA, April 14, 1989; 261(14): 2109 - 2115. [Abstract] [PDF]

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				M. A. Habbab and J. I. Haft Heparin Resistance Induced by Intravenous Nitroglycerin: A Word of Caution When Both Drugs Are Used Concomitantly Arch Intern Med, May 1, 1987; 147(5): 857 - 860. [Abstract] [PDF]

				Drugs Five Years Later: Nifedipine in Myocardial Ischemia, Systemic Hypertension, and Other Cardiovascular Disorders Ann Intern Med, November 1, 1986; 105(5): 714 - 729. [Abstract] [PDF]