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KMID : 0368120130430090607
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Korean Circulation Journal
2013 Volume.43 No. 9 p.607 ~ p.614
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Comparison of Coronary Plaque Components between Non-Culprit Lesions in Patients with Acute Coronary Syndrome and Target Lesions in Patients with Stable Angina: Virtual Histology-Intravascular Ultrasound Analysis
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Hong Young-Joon
Jeong Myung-Ho
Choi Yun-Ha
Park Soo-Young
Rhew Si-Hyun
Jeong Hae-Chang
Cho Jae-Yeong
Lee Ki-Hong
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
Jang Su-Young
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Abstract
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Background and Objectives: The differences in plaque characteristics between non-culprit lesions (NCL) in acute coronary syndrome (ACS) patients (ACS-NCL) and target lesions (TL) in stable angina (SA) patients (SA-TL) are not well understood. We used a virtual histology-intravascular ultrasound (VH-IVUS) to compare the plaque components between ACS-NCL and SA-TL.
Subjects and Methods: We compared VH-IVUS findings between 290 ACS-NCL and 276 SA-TL. VH-IVUS classified the color-coded tissue into four major components: green (fibrotic); yellow-green (fibro-fatty); white {dense calcium (DC)}; and red {necrotic core (NC)}. Thin-cap fibroatheroma (TCFA) was defined as a NC ≥10% of the plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of ≥40% plaque burden.
Results: Although the plaque burden was significantly smaller (52±13% vs. 54±14%, p=0.044), ACS-NCL had a greater %NC area (17.9±11.6% vs. 14.3±8.7%, p<0.001) and %DC area (9.7±9.8% vs. 8.1±8.0%, p=0.032) compared with SA-TL at the minimum lumen site. By volumetric analysis, ACS-NCL had a greater %NC volume (15.8±9.2% vs. 13.9±7.4%, p=0.006) compared with SA-TL. TCFA was observed more frequently in ACS-NCL compared with SA-TL (27.6% vs. 18.1%, p=0.032). Independent predictors of TCFA by multivariate analysis were ACS {odds ratio (OR): 2.204, 95% CI: 1.321-3.434, p=0.021} and high-sensitivity C-reactive protein (OR: 1.101; 95% CI 1.058-1.204, p=0.035).
Conclusion: Although the plaque burden was significantly smaller, ACL-NCL had more vulnerable plaque components compared with SA-TL, and ACS and high-sensitivity C-reactive protein were the independent predictors of TCFA.
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KEYWORD
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Acute coronary syndrome, Angina, stable, Atherosclerotic plaque, Ultrasonography, intravascular
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