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ȣ - 550059 276 |
| Frequency and Distribution of Thin-Capped Fibroatheroma in the Left Main Coronary Artery: A Virtual Histology Intravascular Ultrasound Analysis |
| 중앙대학교병원 심장혈관센터¹, Cardiovascular Research Foundation² |
| 김상욱¹ , Gary S. Mintz² , 이왕수¹, 조준환¹ , 민윤주¹ , 김경준 ¹, 권지은¹ , 오민석¹, 홍준화¹ , 김향경¹ , 석주원¹ , 이광제¹ , 김치정¹ , 조대윤¹, 김태호¹ |
We assessed the frequency and distribution of Virtual Histology Intravascular Ultrasound (VH-IVUS) thin-capped fibroatheromas (VH-TCFA) in the left main coronary artery (LM) in 423 pts. VH-TCFA was defined as necrotic core (NC) >10% of plaque area within a plaque burden of >40% and >30° NC abutting the lumen in at least 3 consecutive frames. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane] area) >1.05. Results. Overall, the frequency of VH-TCFA was only 10.4% (44/423); 30 in pts with acute coronary syndrome and 14 in pts with stable angina. Pt age 63±12 yrs vs 61±11 yrs) and diabetes frequency (27% vs 27%) were similar in LM-TCFA vs LM without TCFA. LM length and EEM area was similar in LM with vs without VH-TCFA; however, minimal lumen area was smaller in LM-TCFA (p<0.0001, Table). Although LM-TCFA had a higher plaque burden (p<0.0001), larger necrotic core area (p<0.0001), and more dense calcium (p=0.0002) at the maximum NC site compared to LM without TCFA, positive remodeling was present in only 18% (8/44) of LM-TCFA. Overall, 59% of LM-TCFA were located in mid-body and the rest at the distal bifurcation. Minimal lumen area was smaller in mid-body LM-TCFA vs distal LM-TCFA (9.12±3.62 mm2 vs 11.89±3.34 mm2, p=0.017). Plaque composition including necrotic core area was similar. Conclusion. LM-VH-TCFA are clustered in mid-body of the left main artery with infrequent positive remodeling.
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LM-TCFA
(n=44) |
LM non-TCFA
(n=379) |
p-value |
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LM length (mm) |
9.88±5.29 |
9.24±3.62 |
0.052 |
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Minimal lumen area (mm2) |
10.27±3.87 |
13.66±4.54 |
<0.0001 |
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EEM area (max.NC site, mm2) |
25.31±5.14 |
24.93±5.60 |
0.662 |
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Lumen area (max.NC site, mm2) |
11.36±3.99 |
14.69±4.85 |
<0.0001 |
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Plaque area (max.NC site, mm2) |
13.95±3.31 |
10.21±3.79 |
<0.0001 |
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Plaque burden (max.NC site, %) |
55.71±11.01 |
41.26±12.82 |
<0.0001 |
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Remodeling index |
0.99±0.04 |
1.00±0.10 |
0.553 |
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Average fibrotic area (%) |
56.39±11.48 |
66.33±36.10 |
0.00018 |
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Average fibrofatty area (%) |
6.43±4.20 |
12.35±9.78 |
0.00012 |
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Average necrotic core area (%) |
26.68±8.94 |
13.07±9.24 |
<0.0001 |
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Average dense calcium (%) |
9.74±5.93 |
5.85±6.55 |
0.00021 |
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