Arterial Remodeling in Unstable Angina. Differences According to Clinical Presentation and Time From Symptoms Onset. An Intraventricular Ultrasound Study

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Abstract

Background

Several authors have shown the association between positive remodeling evaluated by intravascular ultrasound (IVUS) in patients with acute coronary syndrome as compared with patients with stable coronary angina. However, unstable coronary syndromes are a heterogenous group of patients and the role of the different forms of clinical presentations as well as the time from the symptoms onset in the remodeling process have not been evaluated. The aim of the present study is to determine whether different forms of clinical presentations and the timing from symptoms onset may influence the remodeling process in patients with acute coronary syndromes.

Material and method

Retrospectively, 105 patients undergoing PTCA guided by IVUS were included in the present study.From those, 46 were stable patients and 59 were unstable (18.7% progressive angina, 64.4% recent onset angina, and 16.9% recent acute MI, more than48 hours and less than 30 days). In addition, to evaluate the influence of time, patients with recent on set angina were divided in those with <_ 7 days,8 to 30 days and 31 to 90 days.

Results

The remodeling index was of 0,9 ± 0.2 in chronic angina patients, 0.83 ± 0.17 in progressive angina,1.01 ± 0.24 in recent onset angina, and 1.10 ± 0.13 in recent MI patients (p = 0.037). The proportion of positive remodeling was of 21.7%,9.1%,42.1%, and60% (p = 0.054), and of negative remodeling was of63%,72.7%,42.1%, and 10% (p = 0.016) respectively.Patients with recent onset angina the remodeling index was 1.08 ± 0.23, 0.97 ± 0.21 and 0.91 ± 0.29, and the proportion of positive remodeling was of58.8%, 35.7% and 14.3% for <_ 7 days, 8-30 days and31-90 days from symptoms onset respectively.

Conclusions

Arterial remodeling in the context of unstable angina is a heterogenous process. Patients with re-cent MI or recent onset angina have a significantly higher remodeling index and a significantly higher proportion of lesions with positive remodeling, whereas patients with progressive angina show are modeling process closer to patients with chronic angina symptoms. In addition, the time from the symptoms onset appears to play a role in the re-modeling process, with a tendency to progress to a negative remodeling with a longer symptoms duration.