Author + information
- Received April 16, 1992
- Revision received November 4, 1992
- Accepted November 13, 1992
- Published online May 1, 1993.
- Stefan Jost, MD∗,a,
- Jaap W. Deckers, MDa,∗,
- Peter Nikutta, MDa,
- Wolfgang Rafflenbeul, MDa,
- Birgitt Wiese, PhDa,
- Hartmut Hecker, PhDa,
- Peter Lippolt, MDa,
- Paul R. Lichtlen, MD, FACCa,
- INTACT Investigatorsa
- ↵∗Address for correspondence: Stefan Jost, MD, Hannover Medical School, Department of Cardiology, Box 61 01 80, 3000 Hannover 61, Germany.
Objectives. This study represents the first prospective, quantitative analysis of the association of progression of coronary atherosclerosis with anatomic site and diameter.
Background. The progressive course of coronary artery disease has been documented in many angiographic follow-up trials.
Methods. The data of 348 patients with coronary artery disease from the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT) were reviewed. Standardized coronary angiograms were taken 3 years apart and were analyzed quantitatively. The coronary tree was subdivided into 25 segments. The progression of 1,063 preexisting coronary stenoses and the appearance of 247 newly formed stenoses was assessed in relation to the mean diameter of segments (<2 mm, 2 to 3 mm, >3 mm) and to their position in the coronary tree (proximal, mid, distal) and in the three major coronary arteries.
Results. Decreases in the minimal diameter of preexisting stenoses were largest in segments that were >3 mm in diameter (mean ± SD 0.23 ± 0.5 mm vs. 0.10 ± 0.4 mm and 0.02 ± 0.3 mm, p < 0.001), in a proximal position (0.14 ± 0.5 mm vs. 0.09 ± 0.4 mm and 0.06 ± 0.3 mm, p = 0.081) and in the right coronary artery (0.14 ± 0.4 mm vs. 0.07 ± 0.4 mm and 0.07 ± 0.3 mm, p < 0.01). Changes in percent diameter stenosis of preexisting stenoses were lowest in segments that were <2 mm in diameter and in a distal position (p = NS). The number of new stenoses/segment was lowest in segments that were <2 mm in diameter (44 of 1,756 vs. 139 of 1,967 and 64 of 1,125, p < 0.001) and in a distal position (77 of 2,370 vs. 84 of 1,193 and 86 of 1,285, p < 0.001) and was highest in segments of the right coronary artery (100 of 1,546 vs. 66 of 1,496 and 72 of 1,492, p = 0.044).
Conclusions. Progression of coronary artery disease occurs most frequently in coronary segments that are >2 mm in diameter, in a proximal or midartery position and in the right coronary artery.
☆ INTACT was supported by an educational grant of Bayer AG. Wuppertal, Germany. A complete list of INTACT investigators is published in Reference 13.
- Received April 16, 1992.
- Revision received November 4, 1992.
- Accepted November 13, 1992.