Korean Circ J.  2013 Sep;43(9):607-614. 10.4070/kcj.2013.43.9.607.

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

• Hong YJ
• Jeong MH
• Choi YH
• Park SY
• Rhew SH
• Jeong HC
• Cho JY
• Jang SY
• Lee KH
• Park KH
• Sim DS
• Yoon NS
• Yoon HJ
• Kim KH
• Park HW
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 2224816
• DOI: http://doi.org/10.4070/kcj.2013.43.9.607

Abstract

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 > or =10% of the plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of > or =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.

Keyword

Acute coronary syndrome; Angina, stable; Atherosclerotic plaque; Ultrasonography, intravascular

MeSH Terms

Acute Coronary Syndrome
Angina, Stable
C-Reactive Protein
Calcium
Humans
Multivariate Analysis
Plaque, Atherosclerotic
Ultrasonography, Interventional
C-Reactive Protein
Calcium

Figure

• 

  Fig. 1 Plaque component analysis between ACS-NCL (non-culprit lesion in patients with acute coronary syndrome) and SA-TL (target lesion in patients with stable angina) at the minimum lumen sites. Results are displayed for (A) absolute and (B) relative quantifications. FT: fibrotic, FF: fibro-fatty, DC: dense calcium, NC: necrotic core.

• 

  Fig. 2 Plaque component analysis between ACS-NCL (non-culprit lesion in patients with acute coronary syndrome) and SA-TL (target lesion in patients with stable angina) at the largest necrotic core sites. Results are displayed for (A) absolute and (B) relative quantifications. FT: fibrotic, FF: fibro-fatty, DC: dense calcium, NC: necrotic core.

• 

  Fig. 3 Volumetric plaque component analysis between ACS-NCL (non-culprit lesion in patients with acute coronary syndrome) and SA-TL (target lesion in patients with stable angina). Results are displayed for (A) absolute and (B) relative quantifications. FT: fibrotic, FF: fibro-fatty, DC: dense calcium, NC: necrotic core.

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