Author + information
- Received March 13, 1990
- Revision received August 22, 1990
- Accepted September 7, 1990
- Published online February 1, 1991.
- Danna E. Johnson, MD*,1,
- Edwin L. Alderman, MD, FACC§,1,
- John S. Schroeder, MD, FACC1,
- Shao-Zhou Gao, MD1,
- Sharon Hunt, MD, FACC1,
- William M. DeCampli, MD, PhD1,
- Edward Stinson, MD, FACC1 and
- Margaret Billingham, MB, BS, FRCPath1
- ↵§Address for reprints: Edwin L. Alderman, MD, Stanford University Medical Center, H2321, Stanford, California 94305.
Accelerated coronary artery disease is a major cause of morbidity and mortality among cardiac transplant recipients. Ten patients who died or underwent retransplantation within 2 months of coronary angiography had direct correlation of angiographic (normal discrete lesions, diffuse concentric narrowing) with histologic appearance of coronary arteries. Of the 26 angiographi-cally normal segments, 73% showed mild to moderate fibrous intimai thickening by light microscopy. The remainder had intermediate lesions or atheromatous plaques. Discrete stenoses usually corresponded to lipid-rich intermediate or atheromatous disease. In contrast, angiographically diffuse, concentrically narrowed lesions usually were areas of severe fibrous intimai thickening. Fresh or organizing thrombus was most often associated with discrete lesions and accounted for all complete occlusions.
Histologic and angiographic comparisons of the degree of luminal narrowing showed generally good correlation for high grade stenoses. Lesions graded as having <25% diameter narrowing were often underestimated angiographically as compared with histologic determinations. Transplant coronary artery disease has a heterogeneous histologic and angiographic appearance, with angiographic underestimation of disease in some patients.
- Received March 13, 1990.
- Revision received August 22, 1990.
- Accepted September 7, 1990.
- American College of Cardiology Foundation