Process of Progression of Coronary Artery Lesions From Mild or Moderate Stenosis to Moderate or Severe Stenosis

Abstract

Background —The process of progression in coronary artery disease is unknown. Methods and Results —The subjects were 36 patients with 36 objective vessels with clinically significant progression of coronary artery disease (≥15% per year) in whom 4 serial coronary arteriograms (CAGs) were performed at intervals of ≈4 months in a 1-year period. The degree of progression of percent stenosis between each of 2 serial CAGs was classified as marked (M: ≥15%), slight (S: 5% to 14%), and no progression (N: <5%). From the pattern of progression, the 36 vessels were classified as 14 type 1 vessels with marked progression (N→N→M in 13 vessels and S→S→M in 1 vessel) and 22 type 2 vessels without marked progression (S→S→S in 18 vessels, N→S→S in 4). Percent stenosis at the first, second, third, and final CAGs was 44±14%, 46±13%, 46±13%, and 88±10% ( P <0.05 versus first CAG) in type 1 vessels and 44±11%, 50±9%, 59±9%, and 67±9% in type 2 vessels ( P <0.05 for second, third, and final CAGs versus first CAG). Type 1 vessels featured the sudden appearance of severe stenosis due to marked progression, angina pectoris, or myocardial infarction (71%) and Ambrose type II eccentric lesions indicating plaque rupture or thrombi (57%). Type 2 vessels featured continuous slight progression of stenosis with smooth vessel walls; angina pectoris (14%) occurred when the percent stenosis reached a severe level. An increase in serum C-reactive protein was observed only in the type 2 vessel group, which suggests a relation between continuous slight progression and inflammatory change. Conclusions —Two types of stenosis progression provide a new insight into the mechanism of coronary artery disease.