A Three-Vessel Virtual Histology Intravascular Ultrasound Analysis of Frequency and Distribution of Thin-Cap Fibroatheromas in Patients With Acute Coronary Syndrome or Stable Angina Pectoris

Myeong Ki Hong, Gary S. Mintz, Cheol Whan Lee, Jeong Woo Lee, Jae Hyoung Park, Duk Woo Park, Seung Whan Lee, Young Hak Kim, Sang Sig Cheong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

The frequency and distribution of thin-cap fibroatheromas (TCFA) have important clinical implications. We evaluated the frequency and distribution of TCFA identified by virtual histology intravascular ultrasound (VH-IVUS) in acute coronary syndrome (ACS) and stable angina pectoris (SAP). Preintervention 3-vessel VH-IVUS was performed in 105 patients with ACS and 107 with SAP. The length of left anterior descending artery imaged was 72 ± 16 mm-54 ± 12 mm in the left circumflex and 92 ± 19 mm in the right coronary. VH-IVUS-derived TCFA (VH-TCFA) had a necrotic core ≥10% of plaque area without overlying fibrous tissue in a plaque burden ≥40%. There were 76 ruptured plaques (55 in ACS and 21 in SAP) and 439 VH-TCFA (262 in ACS and 177 in SAP, 2.5 ± 1.5 vs 1.7 ± 1.1 TCFA per patient with ACS and with SAP, respectively; p <0.001). Twelve patients with ACS and 1 with SAP had multiple ruptured plaques (p <0.001); 76 patients with ACS and 58 with SAP had multiple VH-TCFA (p = 0.009). Presentation of ACS was the only independent predictor for multiple ruptured plaques (p = 0.013) or multiple VH-TCFA (p = 0.011). Eighty-three percent of VH-TCFA were located within 40 mm of the coronary: 111 ≤10 (25%), 110 from 11 to 20 (25%), 83 from 21 to 30 (19%), and 61 from 31 to 40 mm (14%). The axial distribution of VH-TCFA was similar in patients with ACS and those with SAP and was similar to the axial distribution of ruptured plaques. In conclusion, 3-vessel VH-IVUS imaging showed a higher frequency of VH-TCFA in primary and secondary lesions in patients with ACS compared with those with SAP, but showed a similar clustering of VH-TCFA in the proximal 40 mm of each coronary artery.

Original languageEnglish
Pages (from-to)568-572
Number of pages5
JournalAmerican Journal of Cardiology
Volume101
Issue number5
DOIs
Publication statusPublished - 2008 Mar 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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