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KMID : 0368120110410080440
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Korean Circulation Journal
2011 Volume.41 No. 8 p.440 ~ p.446
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Relation Between High-Sensitivity C-Reactive Protein and Coronary Plaque Components in Patients With Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis
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Hong Young-Joon
Jeong Myung-Ho
Choi Yun-Ha
Cho Suk-Hee
Hwang Seung-Hwan
Ko Jum-Suk
Lee Min-Goo
Park Keun-Ho
Sim Doo-Sun
Yoon Nam-Sik
Yoon Hyun-Ju
Kim Kye-Hun
Park Hyung-Wook
Kim Ju-Han
Ahn Young-Keun
Cho Jeong-Gwan
Park Jong-Chun
Kang Jung-Chaee
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Abstract
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Background and Objectives : We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and plaque components in 279 acute coronary syndrome (ACS) patients.
Subjects and Methods : We divided patients into three groups according to their hs-CRP levels {lowest tertile <0.07 mg/dL (n=93), middle tertile ≥0.07, <0.4 mg/dL (n=93), and highest tertile ≥0.4 mg/dL (n=93)}. Thin-cap fibroatheroma (TCFA) was defined as focal, necrotic core (NC)-rich (≥10% of the cross-sectional area) plaques in contact with the lumen in a plaque burden ≥40%.
Results: The highest tertile group was mostly diabetics (20%, 27%, 40%, p=0.009), and had the greatest plaque plus media volume (163±139/mm3 vs. 201±155/mm3 vs. 232±176/mm3, p=0.013). The highest tertile group had the greatest absolute and % NC volumes (13.6±15.1 mm3 vs. 14.8±14.2 mm3 vs. 23.7±24.3 mm3, p<0.001, and 14.9±8.7% vs. 16.0±8.7% vs. 19.5±10.2%, p=0.024, respectively). The culprit lesion TCFA was observed most frequently in the highest tertile group (28% vs. 35% vs. 55%, p=0.006). By multivariable analysis, absolute NC volume was an independent predictor of hs-CRP elevation {odds ratio (OR); 1.03, 95% confidence interval (CI)=1.06-1.21, p=0.004}, and hs-CRP was an independent predictor of TCFA (OR; 1.86, 95% CI=1.11-2.90, p=0.010).
Conclusion: VH-IVUS analysis has demonstrated that ACS patients with elevated hs-CRP have more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFA), compared with ACS patients with normal hs-CRP.
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KEYWORD
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Acute coronary syndrome, Plaque, atherosclerotic, Inflammation, Ultrasonography, interventional
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