Presentations of acute coronary syndrome related to coronary lesion morphologies as assessed by intravascular ultrasound and optical coherence tomography

Kato, Masaya; Dote, Keigo; Sasaki, Shota; Kagawa, Eisuke; Nakano, Yoshinori; Watanabe, Yoshikazu; Higashi, Akifumi; Itakura, Kiho; Ochiumi, Yusuke; Takiguchi, Yu

doi:10.1016/j.ijcard.2011.09.032

Cited by 29 publications

(14 citation statements)

References 33 publications

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“…18 In a previous study, abdominal obesity was an independent predictor of rupture of a culprit plaque. [19][20][21] Our current data also demonstrated more frequent plaque rupture of culprit lesions in patients with high BMI along with a greater plaque burden and a larger necrotic core. Similar to the previous data, BMI was the independent predictor of plaque rupture.…”

Section: Discussionsupporting

confidence: 72%

Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

Kang

Mintz

Witzenbichler

et al. 2015

Circ: Cardiovascular Interventions

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O besity contributes to the development and progression of coronary artery disease and adverse events, in part, by reducing insulin sensitivity and promoting basal sympathetic tone, hypercoagulability, and systemic inflammation. 1,2 Conversely, in patients with established coronary artery disease, the effect of obesity on clinical outcomes remains controversial. [3][4][5][6] Recent studies suggest that an increased body mass index (BMI) is associated with a decreased mortality and major adverse cardiac events, especially in patients who undergo percutaneous coronary intervention (PCI) 7,8 ; however, the mechanism of the so-called obesity paradox is not yet understood.Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) 9 was a large-scale, prospective, multicenter study designed to assess the relationship between platelet reactivity and other clinical and procedural variables versus subsequent stent thrombosis and other adverse clinical events in patients treated with DES. In an intravascular Background-Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood. Methods and Results-Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4 2 ) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts. Conclusions-A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794. Kang et al Effect of Obesity in Coronary Atherosclerosisultrasound (IVUS) substudy, culprit lesions were prospectively evaluated using grayscale and virtual histology (VH)-IVUS, and patients were treated with IVUS-guided DES implantation. The aims of the...

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Section: Discussionsupporting

confidence: 72%

Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

Kang

Mintz

Witzenbichler

et al. 2015

Circ: Cardiovascular Interventions

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“…The recent progress in non-invasive imaging techniques, as represented by CCTA, has enabled noninvasive visualization of coronary plaques along with plaque quantification. 23) Several studies that compared CCTA with intravascular ultrasound have validated the role of CCTA for the detection of coronary plaques, reporting sensitivities and specifi cities that vary between 80 and 90%. 24,25) However, CT imaging is not restricted only to plaque visualization, as it provides additional information regarding plaque burden, composition and remodeling, which are directly correlated with plaque vulnerability.…”

Section: Discussionmentioning

confidence: 99%

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

Benedek

Beáta²,

Benedek

2014

Int. Heart J.

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SummaryThe purpose of this study was to demonstrate the relationship between the presence and amount of a low-density core (LDC) with a CT density < 30 Hounsfi eld units (HU) by coronary computed tomography angiography (CCTA) and IVUS-derived markers of vulnerability in the culprit lesions (CL) of patients with acute coronary syndromes (ACS).In 43 patients with ACS, 105 coronary plaques were scanned using CCTA and IVUS for the quantitative and qualitative assessment of vulnerability markers.The presence of a low attenuation plaque (LAP) was identifi ed in 67.4% of the CL and 29.03% of the non-CL (P = 0.0001). The presence of a LDC > 6.0 mm 3 was signifi cantly correlated with the percentage of the necrotic core (NC) (22.08% versus 7.97%, P = 0.001) and the fi bro-fatty tissue by IVUS (18.68% versus 15.87%, P = 0.02). LDC volumes showed a good correlation with the percentage of the NC (r = 0.7303, P < 0.0001) and the fi bro-fatty tissue in the CL (r = 0.4928, P < 0.0008). Quantitative plaque analysis revealed a signifi cant difference in plaque composition between CL and non-CL in regards to the LDC (18.45 versus 6.5, P < 0.001), the percentage of NC (20.74 versus 18.74, P = 0.02), fi bro-fatty tissue (17.77 versus 15.48, P = 0.002), and fi brotic tissue (51.68 versus 54.8, P = 0.01).VH-IVUS and CCTA plaque quantifi cation showed that the presence of a low-density (< 30 HU) core within the CL of patients with ACS represents a marker of vulnerability and correlates well with other CCTA and IVUS-derived features of vulnerability, particularly the NC of the plaque. (Int Heart J 2014; 55: 22-28)

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“…optyczna koherentna tomografia) mogą się niekiedy okazać przydatne w identyfikacji zmian odpowiedzialnych za niedokrwienie lub patologii leżą-cych u ich podstaw, tj. pogrubienie warstwy środkowej tętnicy spowodowane jej nieprawidłowym obkurczeniem w skurczu tętnicy wieńcowej lub powierzchowne nadżerki w obrębie pokrywy włóknistej w zmianie miażdżycowej niepowodującej istotnego zwężenia [318][319][320].…”

Section: Identyfikacja Zmiany Odpowiedzialnej Za Niedokrwienieunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

208

165

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Presentations of acute coronary syndrome related to coronary lesion morphologies as assessed by intravascular ultrasound and optical coherence tomography

Cited by 29 publications

References 33 publications

Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

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