Factors leading to coronary remodeling and relationship between remodeling patterns and clinical presentation remain unclear.

Seventy-five culprit lesions of 75 patients with acute coronary syndrome(ACS)(n=9) and stable angina(SA)(n=6)(60 men and 15 women; mean age 56±10 years) were studied by intravascular ultrasound. Remodeling index(RI) was calculated as culprit lesion vessel area(VA)/proximal reference VA. We defined: 1)compensatory remodeling(CpR) as RI≥1.1; 2)constrictive remodeling(CsR) as RI≤0.9; 3)no remodeling(NR) as 0.9<RI<1.1.

Twenty-three(31%) lesions had CpR, 37(49%) had CsR and 15(20%) had NR. No significant differences in remodeling patterns were noted with respect to coranary risk factors. Soft plaques were more prevalent in lesions with CpR, whereas hard plaques were more prevalent in lesions with CsR(p<0.001). Lesions with CpR had significantly smaller proximal reference VA than those with NR or CsR(p<0.05). Plaque characteristics were similar in ACS and SA patients. However, more culprit lesions with CpR were present in patients with ACS(21/49 vs 3/26, p<0.01), whereas more culprit lesions with CsR were noted in patients with SA(18/26 vs 19/49, p<0.05).

Local factors such as plaque characteristics and vessel size appear to be associated with remodeling patterns. The type of remodeling is more related to clinical presentation than plaque characteristics.