SHAPE Society

1. Stenosis Severity & Risk of Coronary Occlusion
0
10
20
30
40
50
60
70
80
90
100
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
0
50
100
150
200
250
300
350
400
2161
None 5-49% 50-80% 81-95%
52 21
1% 2% 10% 24%
Stenosis Severity at Baseline
CoronarySegments(n)
Occlusions at 5-Year Follow-Up
Alderman et al, JACC 1993;22:1141-1154

2. Stenosis Severity and Associated Risk of MI
0
10
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100
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
0
100
200
300
2674
0% 2% 50% 75% 90-99%
29 10
0.3% 3.5% 4.1% 7.9%
Stenosis Severity Prior to MI
CoronarySegments(n)
MI Culprit Lesions at Follow-Up
Nobuyoshi et al, JACC 1991;18:904-910
8.7%

3. Majority of Infarcts Evolve from
Angiographically Mild to Moderate Stenoses
Falk et al, Circulation 1995;92:657-671
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1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
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MIPatients(n)
Ambrose
1988
Little
1988
Nobuyoshi
1991
Giroud
1992
All
Stenosis Prior to MI
>70%
50-70%
<50%
0
20
40
60
80
100
120
140
160
180
200
68%
18%
14%

4. 235
103
18
237
108
18
313
101
16
0
50
100
150
200
250
300
350
Niacin + resin, n=27
Lovastatin + resin, n=32
Diet + resin, n=53
Mild stenosis
<40%
Moderate stenosis
40-70%
Severe stenosis
>70%
Coronarysegments(n)
4 41 2 1 1
4/785
5/312 4/52
Stenosis Severity and Associated Risk of ACS
Insights from FATS

5. •Severely stenotic plaques progress
to total occlusion and myocardial
infarction more frequently than mildly
stenotic plaques
Key Points

6. •Two-thirds of acute CAD
syndromes evolve from mildly
obstructive plaques because
they by far outnumber the
severely obstructive lesions
Key Points

7. • Ruptured plaques have:
Large lipid cores
Thin fibrous cap
Increased inflammation and MMPs
Increased neovascularity
Reduced collagen and SMCs
Key Points