Abstract
Percutaneous transluminal coronary angioscopy was performed in 180 consecutive patients anatomically suitable angioscopy to investigate the pathogenesis of ischemic heart disease. Good pictures for analysis were obtained in 134 patients (22 with an acute myocardial infarction, 28 with a recent myocardial infarction, 37 with an old myocardial infarction, 18 with an unstable angina, 23 with a stable angina, and 6 with a vasospastic angina). Thrombi were observed in most patients with an acute myocardial infarction, a postinfarction angina, and an unstable angina. Yellow atheromas were observed more frequently in patients with an acute myocardial infarction, an unstable angina, and a recent myocardial infarction. The frequency of an intimal damage was significantly higher in patients with an acute myocardial infarction, an unstable angina, a recent myocardial infarction, and a vasospastic angina.
The progression of stenosis in coronary lesions of 10 patients who had previously undergone arteriography and were later hospitalized for an episode of unstable angina, and compared them to the findings in 10-matched stable angina patients who had undergone prior coronary arteriography. Stenotic progression occurred in 9 of 10 patients with an unstable angina but in 5 of 10 patients with a stable angina. And there was a significant difference in the degree of stenotic progression between 2 groups.
Relationships between the progression of the coronary stenosis and the plasma lipid levels in the stable angina were studied in 102 patients. Forty-four patients were revealed as showing a stenotic progression of their coronary artery disease and 56 patients did not. At both the first and the second arteriography, the values of the total cholesterol, Apo B, Apo C-II, Apo E and Apo B/A-I were significantly higher in the stenotic progression group than in the group showing no such progression.
In conclusion, the presence of thrombi may be important factor in the pathogenesis of acute coronary disease and in the stenotic progression of a coronary obstruction in patients with an unstable angina. Further, the plasma lipid levels and the apolipoproteins appear to play an important role in the progression of coronary artery stenosis in patients with a stable angina.
