Korean Circ J.  2007 Sep;37(9):437-442. 10.4070/kcj.2007.37.9.437.

In-Vivo Coronary Plaque Composition in Patients with Acute Coronary Syndrome: A Virtual Histology Intravascular Ultrasound Study

• Bae JH
• Kwon TG
• Kim KH
• Hyun DW
• Kim KY
• Kim DS

• KMID: 2093981
• DOI: http://doi.org/10.4070/kcj.2007.37.9.437

Abstract

BACKGROUND AND OBJECTIVES: Rupture-prone plaque, characterized by a large necrotic core, thin fibrous cap and large number of inflammatory cells, is known to be associated with acute coronary syndrome (ACS) from several autopsy and animal studies. We sought to assess in-vivo lesion characteristics of culprit lesions in patients with ACS.
SUBJECTS AND METHODS
One hundred consecutive patients (mean age 60.4 years, 70 males), who underwent percutaneous coronary intervention, were analyzed for intravascular ultrasound (IVUS) radiofrequency information using IVUS-virtual histology (VH) software.
RESULTS
Patients with ACS (n=44, mean 59.7 years, 34 males) had a lower prevalence of hypertension (45.5% vs. 67.9%, p=0.024), higher level of high-sensitivity C-reactive protein (0.36+/-0.36 mg/dL vs. 0.22+/-0.27, p=0.043), longer lesion length (22.6+/-8.6 mm vs. 19.3+/-6.9 mm, p=0.036), and more plaque rupture (63.6% vs. 10.7%, p<0.001) than those without ACS (mean 61.0 years 36 males). The lesion analysis, at a minimal luminal area, revealed that patients with ACS had a larger plaque area (12.5+/-5.8 mm2 vs. 10.3+/-4.8 mm2, p=0.043) and necrotic core (1.7+/-1.4mm2 vs. 1.1+/-0.9 mm2, p=0.013) than those patients without ACS. Volumetric analysis over the lesion length showed that patients with ACS had larger plaque volume (9.9+/-4.0 mm3/mm vs. 8.3+/-3.4 mm3/mm, p=0.031) and necrotic core volume (1.3+/-1.0 mm3/mm vs. 0.8+/-0.6 mm3/mm, p=0.002) than those without ACS. The necrotic core volume was associated with the presence of ACS (beta=0.662, p=0.041) by the IVUS-VH findings.
CONCLUSION
The results of this study suggest that the overall necrotic core volume, not the necrotic core area at the minimal luminal area, is associated with the clinical presentation of ACS.

Keyword

Histopathology; Coronary disease; Intravascular ultrasonography

MeSH Terms

Acute Coronary Syndrome*
Animals
Autopsy
C-Reactive Protein
Coronary Disease
Humans
Hypertension
Percutaneous Coronary Intervention
Phenobarbital
Prevalence
Rupture
Ultrasonography*
Ultrasonography, Interventional
C-Reactive Protein
Phenobarbital

Figure

• 

  Fig. 1 Cross-sectional images of virtual histology (VH) and gray-scale intravascular ultrasound (IVUS) from distal to proximal within a same lesion in A (patient with stable angina) and B (patient with acute coronary syndrome). VH-IVUS images in patient with acute coronary syndrome (B) shows large plaque area and large amount of necrotic core area throughout the entire lesion length.

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