Korean Circ J.  2013 Jun;43(6):377-383. 10.4070/kcj.2013.43.6.377.

Impact of Plaque Composition on Long-Term Clinical Outcomes in Patients with Coronary Artery Occlusive Disease

• Kim KH
• Kim WH
• Park HW
• Song IG
• Yang DJ
• Seo YH
• Yuk HB
• Park YH
• Kwon TG
• Rihal CS
• Lerman A
• Lee MS
• Bae JH

• KMID: 2224898
• DOI: http://doi.org/10.4070/kcj.2013.43.6.377

Abstract

BACKGROUND AND OBJECTIVES
It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients.
SUBJECTS AND METHODS
The study subjects consisted of 339 consecutive patients (mean 61.7+/-12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period.
RESULTS
Patients with high fibrofatty volume (FFV, >8.90 mm3, n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV< or =8.90 mm3, n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE.
CONCLUSION
FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.

Keyword

Intravascular ultrasonography; Plaque, atherosclerotic; Coronary artery disease

MeSH Terms

Acute Coronary Syndrome
Coronary Artery Disease
Coronary Vessels
Follow-Up Studies
Glycosaminoglycans
Humans
Incidence
Male
Myocardial Infarction
Plaque, Atherosclerotic
Shock, Cardiogenic
Ultrasonography, Interventional
Glycosaminoglycans

Figure

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  Fig. 1 Comparison of Kaplan-Meier curves for major adverse cardiac and cerebrovascular events (MACCE) according to fibrofatty volume (FFV). A log-rank showed a significant difference (p=0.012) between the low FFV (FFV≤8.90 mm3) and high FFV groups (FFV>8.90 mm3).

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