Number of Yellow Plaques Detected in a Coronary Artery Is Associated With Future Risk of Acute Coronary Syndrome

Abstract

Patients with multiple yellow plaques per vessel have a higher risk of suffering ACS events than those with NYP 0 or 1. Angioscopy would be useful to detect vulnerable patients.

Chronic Kidney Disease and Coronary Artery Vulnerable Plaques

“…Although the mechanisms of how CKD increases the cardiovascular events have not been fully understood, we have revealed in the present study that patients with CKD have more coronary yellow plaques than those without CKD and that CKD is an independent risk of multiple yellow plaques per vessel, which we have previously demonstrated to be an independent risk factor for a future ACS event in a prospective clinical trial (6). Furthermore, more than half of yellow plaques in the CKD group represented grade 3, which is compatible with thin-cap fibroatheroma.…”

“…Non-infarct-related arteries were not examined. Multivariate logistic regression analysis was also performed to clarify the associated factors for the multiple coronary yellow plaques that had been proven to be an independent risk of future ACS events (6). Intravenous heparin (100 U/kg) was administered at the beginning of catheterization, and an additional dose was repeated at the time of PCI as a routine protocol in our hospital.…”

“…Yellow plaque was defined simply as the yellow area on the luminal surface, which might have a smooth or irregular surface with or without protrusion into the lumen (6). Yellow color grade of all detected yellow plaques in the nonculprit segments was classified into three grades (1, slight yellow; 2, yellow; 3, intense yellow) according to the standard colors ( Figure 1A) as we previously reported (9), and the maximum yellow color grade of the yellow plaques and the number of yellow plaques in the vessel were determined for each patient as we previously reported (6).…”

“…Yellow color grade of all detected yellow plaques in the nonculprit segments was classified into three grades (1, slight yellow; 2, yellow; 3, intense yellow) according to the standard colors ( Figure 1A) as we previously reported (9), and the maximum yellow color grade of the yellow plaques and the number of yellow plaques in the vessel were determined for each patient as we previously reported (6). The atherosclerosis index was defined as (number of yellow plaques) ϫ (maximum yellow color grade) as previously reported (9).…”

“…However, the mechanisms how CKD increases the risk have not been fully understood: it may accelerate the formation of vulnerable plaques; it may increase the frequency of plaque disruption; and/or it may increase the thrombogenicity of blood. On the other hand, we have revealed in a previous angioscopic study (6) that the number of yellow plaques in a coronary artery is an independent risk of cardiovascular events and that patients with multiple yellow plaques per vessel have 2.2-fold higher risk of suffering acute coronary syndrome (ACS) than patients with no or a single yellow plaque per vessel. Therefore, we assumed that CKD would raise the risk of cardiovascular events by increasing the number of yellow plaques.…”