Abstract
Background: Disruption of the atherosclerotic plaque is a common feature of both acute coronary syndromes and balloon dilatation of coronary artery stenoses.
Hypothesis: The study was undertaken to evaluate whether the known association of cholesterol levels and acute coronary syndromes also exists for the occurrence of angiographically detectable endothelial disruption (ED) following coronary angioplasty.
Methods: For this purpose, we examined 79 consecutive patients (men/women 58/21; mean age: 62 ± 11 years), with a noncalcified, de novo, significant stenosis in a single native coronary artery, undergoing elective coronary intervention because of stable effort angina. Coronary angioplasty was performed using regular balloon catheters, aiming for a balloon/ artery ratio of 1, with stent implantation allowed only provisionally. Following balloon dilatation, patients were divided into two groups according to the presence or absence of angio‐graphically detectable ED.
Results: Endothelial disruption occurred in 28 patients (35%). The two groups with and without ED were comparable with respect to clinical, angiographic, and procedural parameters. A history of hypercholesterolemia was significantly more frequent in patients with ED (93 vs. 2%; p < 0.001). Total and low‐density lipoprotein (LDL) cholesterol levels were significantly higher in the group with ED (230.1 ± 46.5 vs. 204.4 ± 30.2 mg/dl, p < 0.05; and 150.6 ± 39.2 vs. 125.8 ± 26 mg/dl, p < 0.03, respectively). A cut‐off value of LDL cholesterol ≥135 mg/dl identified patients at higher risk of developing ED.
Conclusion: High cholesterol levels appear to favor the occurrence of ED during coronary angioplasty. Aggressive lipid‐lowering therapy and a more careful procedural approach may be warranted in patients with hypercholesterolemia undergoing coronary interventions in order to decrease the occurrence of ED and the associated clinical (acute ischemia) and procedural (stent implantation) consequences.
Keywords: percutaneous coronary interventions, dissection, stent, hypercholesterolemia
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References
- 1. Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 1995; 92:657–671 [DOI] [PubMed] [Google Scholar]
- 2. Davies MJ: Stability and instability: Two faces of coronary atherosclerosis. The Paul Dudley White lecture 1995. Circulation 1996; 94:2013–2020 [DOI] [PubMed] [Google Scholar]
- 3. Yeghiazarians Y, Braunstein JB, Askari A, Stone PH: Unstable angina pec‐toris. N Engl J Med 2000; 342:101–114 [DOI] [PubMed] [Google Scholar]
- 4. Brown BG, Zhao X‐Q, Sacco DE, Albers JJ: Lipid lowering and plaque regression. New insights into prevention of plaque disruption and clinical events in coronary artery disease. Circulation 1993; 87:1781–1791 [DOI] [PubMed] [Google Scholar]
- 5. Vaughan CJ, Gotto AM, Basson CT: The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol 2000; 35:1–10 [DOI] [PubMed] [Google Scholar]
- 6. Lee RT: Plaque stabilization: The role of lipid lowering. Int J Cardiol 2000; 74(suppl): S11–S15 [DOI] [PubMed] [Google Scholar]
- 7. Landau C, Lange RA, Hillis LD: Percutaneous transluminal coronary an‐gioplasty. N Engl J Med 1994; 330:981–993 [DOI] [PubMed] [Google Scholar]
- 8. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, Gaglione A, Goldberg SL, Tobis JM: Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91:1676–1688 [DOI] [PubMed] [Google Scholar]
- 9. Freed M, O'Neill WW, Safian RD: Dissection and acute closure In The New Manual of Interventional Cardiology (Eds. Freed M, Grines C, Safian RD.), p. 365–372. Birmingham, Mich.: Physicians' Press, 1998. [Google Scholar]
- 10. Huber MS, Mooney JF, Madison J, Mooney MR: Use of a morphologic classification to predict clinical outcome after dissection from coronary an‐gioplasty. Am J Cardiol 1991; 68:467–471 [DOI] [PubMed] [Google Scholar]
- 11. Ryan TJ, Bauman WB, Kennedy JW, Kereiakes DJ, King SB III, McCallister BD, Smith SC Jr, Ullyot DJ: Guidelines for percutaneous trans‐luminal coronary angioplasty. A report of American Heart Association/ American College of CardiologyTask Force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on transluminal coronary angioplasty). Circulation 1993; 88:2987–3007 [DOI] [PubMed] [Google Scholar]
- 12. Schartl M, Bocksch W, Koschyck DH, Voelker W, Karsch KR, Kreuzer J, Hausmann D, Beckmann S, Gross M, for the German Atorvastatin Intravascular Ultrasound Study Investigation (GAIN) : Use of intravascular ultrasound to compare effects of different strategies of lipid‐lowering therapy on plaque volume and composition in patients with coronary artery disease. Circulation 2001; 104:387–392 [DOI] [PubMed] [Google Scholar]
- 13. Yano T, Kawano H, Mochizuki H, Doi O, Nakamura T, Saito Y: Atherosclerotic plaques composed of a large core foam cells covered with thin fibrous caps in twice‐injured carotid arterial specimens obtained from high cholesterol diet‐fed rabbits. J Atheroscler Thromb 2000; 7:83–90 [DOI] [PubMed] [Google Scholar]
- 14. Dorros G, Cowley MJ, Simpson J, Bentivoglio LG, Block PC, Bourassa M, Detre K, Grosselin AJ, Gruentzig AR, Kelsey SF, Kent KM, Mock MB, Mullin SM, Myler RK, Passamani ER, Stertzer SH, Williams DO: Percutaneous transluminal coronary angioplasty: Report of complications from the National Heart, Lung and Blood Institute PTCA Registry. Circulation 1983; 4:723–730 [DOI] [PubMed] [Google Scholar]
- 15. Guiteras VP, Bourassa MG, David PR, Bonan R, Crepeau J, Dyrda I, Lesperance J: Restenosis after successful percutaneous transluminal coronary angioplasty: The Montreal Heart Institute experience. Am J Cardiol 1987; 60(suppl B): 50B–55B [DOI] [PubMed] [Google Scholar]
- 16. Kohchi K, Takebayashi S, Block PC, Hiroki T, Nobuyoshi M: Arterial changes after percutaneous transluminal coronary angioplasty: Results at autopsy. J Am Coll Cardiol 1987; 10:592–599 [DOI] [PubMed] [Google Scholar]
- 17. Tenaglia AN, Buller CE, Kisslo KB, Stack RS, Davidson CJ: Mechanisms of balloon angioplasty and directional coronary atherectomy as assessed by coronary ultrasound. J Am Coll Cardiol 1992; 20:685–691 [DOI] [PubMed] [Google Scholar]
- 18. Bauters C, Lablanche J‐M, Renaud N, McFadden EP, Hamon M, Bertrand ME: Morphological changes after percutaneous transluminal coronary angioplasty of unstable plaques. Insights from serial angioscopic follow‐up. Eur Heart J 1996; 17:1554–1559 [DOI] [PubMed] [Google Scholar]