Quantitative Arteriography in Coronary Intervention Trials: Rationale, Study Design, and Lipid Response in the University of Washington Familial Atherosclerosis Treatment Study (FATS)

Summary

The current technology with greatest precision and statistical efficiency for studying the natural course and the therapy of coronary atherosclerosis is the quantitative analysis of lesion change from serial arteriograms. This approach was used in 47 patients who were electively recatheterized 18 months after the clinically indicated arteriograms, in whom 642 disease coronary segments were identified, representing the entire spectrum of minimal-to-severe atherosclerosis. The frequency distribution of change in the “percent stenosis” (%S) parameter was a bell-shaped curve centered at + 1.6% (average increase in percent stenosis in all lesions in 18 months), with a standard deviation of + 8%. Using three standard deviations of the short-term variability of the Poiseuille flow resistance estimate as a criterion for “true” lesion change, we found that 13.4% of all lesions progressed in 18 months. On average, 16% of all lesions progressed in patients with hyperlipidemia, as compared with 9.9% of lesions in normo-lipidemic patients (p = 0.036).