Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese 2017 05 08() pii S1109-9666(17)30221-X
We aimed to investigate whether the angiographic extent of coronary artery disease (CAD) may differ in patients undergoing coronary angiography for stable CAD or an acute coronary syndrome (ACS) and identify predictors of CAD extent in these patients.
We enrolled 584 consecutive patients (463 with stable CAD, 121 with ACS) with angiographically established CAD (≥1 stenosis >25%). The Gensini score was used to assess the extent of coronary atherosclerosis.
Stable CAD patients had greater Framingham risk score and greater prevalence of hypertension, hypercholesterolemia and diabetes (p<0.05 for all). Fasting glucose, systolic and diastolic blood pressure were higher while high-sensitivity C-reactive protein (hsCRP) was lower in stable compared to ACS patients (p<0.05 for all). No difference in Gensini score was observed between the two groups (p=0.118) but patients with ACS were more likely to have at least one significant epicardial angiographic lesion (>50% stenosis) (OR 2.0, p=0.022). Higher Gensini score was independently associated with i) higher hsCRP and glucose, hypercholesterolemia and increased age in stable CAD patients (R(2) 0.15, p<0001) and ii) increased age, higher glucose and hsCRP in ACS patients (R(2) 0.17, p<0001). CONCLUSIONS
Patients undergoing coronary angiography for ACS or stable CAD presented with similar extent of angiographic CAD, although patients with ACS had a higher prevalence of significant lesions in the presence of a better cardiovascular risk profile and higher inflammation levels. The extent of angiographic CAD in both groups shared common determinants such as hsCRP, age and hyperglycemia, but these appeared to explain only a small part of the variation of coronary atherosclerosis.