Relationship between coronary arterial remodeling, fibrous cap thickness and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome.

BACKGROUND: Thin-capped fibroatheroma (TCFA) is a recognized precursor lesion for acute coronary syndrome (ACS). Positive remodeling (PR) is the predominant pattern of arterial remodeling in patients with ACS. The aim of this study was to evaluate the relationship between coronary arterial remodeling, fibrous cap thickness and high-sensitivity C-reactive protein (hs-CRP) concentration in patients with ACS.

METHODS AND RESULTS: The 47 consecutive ACS patients were enrolled in this study. Arterial remodeling of culprit plaque was assessed by intravascular ultrasound, and fibrous cap thickness was measured by optical coherence tomography. The remodeling index (RI) was calculated as lesion divided by the reference external elastic membrane cross-sectional area, and PR was defined as RI >1.05 (PR group). TCFA were observed more frequently in the PR group than in the intermediate and negative remodeling (IR/NR) groups (59% vs 17%, P<0.01). RI was inversely correlated with fibrous cap thickness (r=0.47, P=0.02). hs-CRP levels were higher in the PR group than in the IR/NR groups (0.32 +/-0.26 vs 0.18 +/-0.14 mg/dl, P=0.02).

CONCLUSIONS: Coronary arterial remodeling, fibrous cap thickness and hs-CRP level in patients with ACS are associated with each other. This result suggests that inflammation simultaneously contributes to both plaque growth and plaque instability.