Plaque Characteristics of the Coronary Segment Proximal to the Culprit Lesion in Stable and Unstable Patients

Abstract

Background: Identifying vulnerable plaque is important for preventing an acute coronary event. The present study examined the relationship between the clinical presentation of coronary artery disease and the plaque characteristics of nonculprit segment assessed by virtual histology intravascular ultrasound (VH-IVUS Results: ACS patients showed significantly higher ratio of dense calcium (7.9%±1.0% versus 5.0%±0.9%, p = 0.03) and necrotic core plaque (13.7%±1.1% versus 8.6%±1.1%, p = 0.001) compared with SA patients. VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) was more frequently observed in ACS patients compared with SA patients (64.6% versus 35.7%, p = 0.006). Among ACS patients, plasma high sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with VH-TCFA than in patients without VH-TCFA (7.9±2.6 mg/l versus 1.6±0.3 mg/l, p = 0.004). Conclusion: ACS patients presented higher prevalence of VH-TCFA in nonculprit segment. Presence of VH-TCFA was associated with an increased level of plasma hs-CRP in ACS patients. IntroductionRecently, virtual histology intravascular ultrasound (VH-IVUS) using spectral analysis of the radiofrequency ultrasound backscatter signals was introduced to clinical practice to characterize plaque composition. 1,2 The purpose of this study was to examine the relationship between the plaque composition of nonculprit segments assessed by VH-IVUS and clinical presentation.

STEMI patients and nonculprit lesions: To treat or not to treat? and when? A review of most recent literature

“…In addition, fibroatheromas that became more stable in appearance over the time tended to be located more distally, whereas fibroatheromas that did not change or that became unstable tended to be located more proximally in the coronary tree . Similar indications derive from the study of Nakamura et al: they showed that thin‐cap fibroatheromas were more common in ACS patients compared with stable patients (64.6% vs. 35.7%, P = 0.006) .…”

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

“…25) Furthermore, a previous report by IVUS also reported that ACS patients showed a significantly higher ratio of NC plaque compared with SAP patients, and VH-IVUS-derived TCFA was more frequently observed in ACS patients compared with SAP patients. 26) In the present study, the ACS group had significantly more %NC and NC volume and less %Fibrous than the SAP group. Additionally, %CD163-positive macrophages were positively correlated with %NC and negatively correlated with %Fibrous in culprit plaque.…”

Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study

“…The prevalence of TCFA in culprit lesions is still controversial, ranging from 21.6 to 60.3% of cases . These results have depend on the population included in each study and the criteria for calling a plaque a TCFA . In the present study, the overall prevalence of iMAP‐derived TCFA was 32.6%, with a greater frequency in culprit lesions (39%) compared to non‐culprit lesions (19%).…”