Objectives: Vulnerable plaque predisposing to plaque rupture is characterized by high lipid content, large inflammatory cells, and thin fibrous cap. We sought to evaluate in vivo tissue characterization of coronary plaque with rupture or ulceration (PRU).
Methods: Study subjects consisted of 162 consecutive patients (mean 60.1±11.9 years old, 119 males) who were underwent intravascular ultrasound-virtual histology (IVUS-VH) examination.
Results: Patients with PRU (n=68, mean 59.5 years old, 52 males) had higher incidence of acute coronary syndrome (89.7% vs. 20.2%, p<0.001), higher troponin-I level (13.7±10.1ng/mL vs. 0.7±3.4ng/mL, p<0.001), higher high sensitivity C-reactive protein level (0.37±0.4mg/dL vs. 0.21±0.3mg/dL, p=0.004), and lower ejection fraction (57.4±10.9% vs. 63.9±10.7%, p<0.001) than those without PRU (n=94, 60.6 years old, 67 males). Patients with PRU had larger lumen (152.5±89.8mm3 vs. 113.8±55.6mm3, p=0.001), vessel (390.8±227.3mm3 vs. 274.0±158.8mm3, p<0.001), plaque (237.6±143.7mm3 vs. 161.4±111.6mm3, p<0.001), fibrous (95.7±66.8mm3 vs. 59.2±52.6mm3, p<0.001), fibrofatty (25.2±25.3mm3 vs. 15.0±19.6mm3, p=0.005), dense calcified (11.4±12.4mm3 vs. 7.7±7.6mm3, p=0.022), and necrotic core volume (27.7±24.5mm3 vs. 17.0±15.3mm3, p=0.001) over the entire lesion length than those without PRU. At the minimal lumen site, patients with PRU had larger vessel (17.6±5.6mm2 vs. 13.7±5.0mm2, p<0.001), plaque (13.6±5.4mm2 vs. 9.8±4.4mm2, p<0.001), fibrous (6.1±3.3mm2 vs. 4.1±2.5mm2, p<0.001), fibrofatty (1.9±2.2mm2 vs. 1.1±1.1mm2, p=0.002), necrotic core area (1.7±1.2mm2 vs. 1.1±0.9mm2, p=0.002), and remodeling index (1.01±0.2 vs. 0.9±0.2mm2, p=0.003). PRU was associated with vessel volume (beta=1.107, p=0.035), plaque volume (beta=-2.743, p=0.011), fibrous volume (beta=1.022, p=0.021), fibrofatty volume (beta=0.522, p=0.008), necrotic core volume (beta=0.684, p=0.005), and remodeling index (beta=0.168, p=0.031).
Conclusions: Coronary plaque composition over the entire lesion, not at the minimal lumen site, is associated with coronary plaque rupture or ulceration.
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