Morphometric analysis of coronary lesions in patients with unstable angina--an arteriographic study.

In 100 patients with unstable angina and 50 patients with stable angina qualitative morphology of coronary artery lesions were compared by angiography. The mean age of the patients was 51 years. In the unstable angina group, 50 patients had rest angina, 32 had crescendo angina and 18 had denovo angina; 31 patients had single vessel disease, 33 had two vessel disease, 34 had triple vessel disease and 2 had left main disease. 'Angina-producing' artery could be identified in 90 out of 100 patients. Ten totally occluded vessels were excluded from analysis. Lesions causing diameter stenosis of greater than 50% could be categorised to one of the following groups: a) Concentric stenosis (18 vessels), b) Type I eccentric lesion (asymmetric narrowing with smooth borders and broad neck--20 vessels), c) Type II eccentric lesion (asymmetric narrowing with narrow neck and overhanging irregular edges--47 vessels), and d) Multiple irregularities (15 vessels). Lesions in 9 vessels showed an associated thrombus. It appears that Type II eccentric lesions are frequent in patients with unstable angina; they probably represent ruptured atherosclerotic plaque or partially occlusive thrombi or both.

Coronary artery disease pattern in the young.

Ninety-two patients aged 40 years or less with documented coronary artery disease were studied with special emphasis on risk factors, coronary angiographic patterns and left ventricular function. Tobacco consumption was the most common risk factor (54%) followed by family history of coronary artery disease (40%). Hyperlipidaemia was not a frequent risk factor. Significant single vessel disease was present in 29% of patients. The incidence of double vessel and triple vessel disease was much higher. The left anterior descending artery was the most commonly involved vessel followed by right and circumflex coronary arteries. Left ventricular function as determined by ejection fraction was abnormal in 51% of patients; left ventricular end diastolic pressure was abnormal in 28% of patients. Sixty-eight percent of patients with no risk factors had either zero vessel or single vessel disease indicating a positive relationship between occurrence of risk factors and significant coronary artery disease in the young.