Relation of Ruptured Plaque Culprit Lesion Phenotype and Outcomes in Patients With ST Elevation Acute Myocardial Infarction

Title
Relation of Ruptured Plaque Culprit Lesion Phenotype and Outcomes in Patients With ST Elevation Acute Myocardial Infarction
Author(s)
김영조김상욱[김상욱]홍영준[홍영준]Gary.S.Mintz[Gary.S.Mintz]이승윤[이승윤]도준형[도준형]임승훈[임승훈]강현재[강현재]라성운[라성운]김종선[김종선]이왕수[이왕수]오성진[오성진]이상[이상]한주영[한주영]이진배[이진배]배장호[배장호]허성호[허성호]한성환[한성환]정명호[정명호]
Keywords
PERCUTANEOUS CORONARY INTERVENTION; RADIOFREQUENCY DATA-ANALYSIS; INTRAVASCULAR ULTRASOUND; THROMBUS ASPIRATION; VIRTUAL HISTOLOGY; ANGINA-PECTORIS; TISSUE CHARACTERIZATION; VULNERABLE PLAQUE; UNSTABLE ANGINA; DEATH
Issue Date
201203
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v.109, no.6, pp.794 - 799
Abstract
We used virtual histology intravascular ultrasound (VU-IVUS) to assess culprit plaque rupture in 172 patients with ST-segment elevation acute myocardial infarction. VH-IVUS-defined thin-capped fibroatheroma (VH-TCFA) had necrotic core (NC) > 10% of plaque area, plaque burden > 40%, and NC in contact with the lumen for >= 3 image slices. Ruptured plaques were present in 72 patients, 61% of which were located in the proximal 30 mm of a coronary artery. Thirty-five were classified as VH-TCFA and 37 as non-VH-TCFA. Vessel size, lesion length, plaque burden, minimal lumen area, and frequency of positive remodeling were similar in VH-TCFA and non-VH-TCFA. However, the NC areas within the rupture sites of VH-TCFAs were larger compared to non-VH-TCFAs (p = 0.002), while fibrofatty plaque areas were larger in non-VH-TCFAs (p < 0.0001). Ruptured plaque cavity size was correlated with distal reference lumen area (r = 0.521, p = 0.00002), minimum lumen area (r = 0.595, p < 0.0001), and plaque area (r = 0.267, p = 0.033). Sensitivity and specificity curve analysis showed that a minimum lumen area of 3.5 mm(2), a distal reference lumen area of 7.5 mm(2), and a maximum NC area of 35% best predicted plaque rupture. Although VH-TCFA (35 of 72) was the most frequent phenotype of plaque rupture in ST-segment elevation myocardial infarction, plaque rupture also occurred in non-VH-TCFA: pathologic intimal thickening (8 of 72), thick-capped fibroatheroma (1 of 72), and fibrotic (14 of 72) and fibrocalcified (14 of 72) plaque. In conclusion, not all culprit plaque ruptures in patients with ST-segment elevation myocardial infarction occur as a result of TCFA rupture; a prominent fibrofatty plaque, especially in a proximal vessel, may be another form of vulnerable plaque. Further study should identify additional factors causing plaque rupture. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109: 794-799)
URI
http://hdl.handle.net/YU.REPOSITORY/29497http://dx.doi.org/10.1016/j.amjcard.2011.10.042
ISSN
0002-9149
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