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Stenosis severity and risk benefit

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Stenosis severity and risk benefit

  1. 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. 2. Stenosis Severity and Associated Risk of MI 0 10 20 30 40 50 60 70 80 90 100 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. 3. Majority of Infarcts Evolve from Angiographically Mild to Moderate Stenoses Falk et al, Circulation 1995;92:657-671 0 10 20 30 40 50 60 70 80 90 100 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr East West North 0 10 20 30 40 50 60 70 80 90 100 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. 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. 5. •Severely stenotic plaques progress to total occlusion and myocardial infarction more frequently than mildly stenotic plaques Key Points
  6. 6. •Two-thirds of acute CAD syndromes evolve from mildly obstructive plaques because they by far outnumber the severely obstructive lesions Key Points
  7. 7. • Ruptured plaques have: Large lipid cores Thin fibrous cap Increased inflammation and MMPs Increased neovascularity Reduced collagen and SMCs Key Points

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