JOURNAL ARTICLE
MULTICENTER STUDY

Longitudinal distribution of plaque burden and necrotic core-rich plaques in nonculprit lesions of patients presenting with acute coronary syndromes

Joanna J Wykrzykowska, Gary S Mintz, Hector M Garcia-Garcia, Akiko Maehara, Martin Fahy, Ke Xu, Andres Inguez, Jean Fajadet, Alexandra Lansky, Barry Templin, Zhen Zhang, Bernard de Bruyne, Giora Weisz, Patrick W Serruys, Gregg W Stone
JACC. Cardiovascular Imaging 2012, 5 (3 Suppl): S10-8
22421223

OBJECTIVES: In this substudy of the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, we examined the longitudinal distribution of atherosclerotic plaque burden, virtual histology-intravascular ultrasound (VH-IVUS) characterized necrotic core (NC) content and VH-thin-cap fibroatheroma (TCFA) distribution in nonculprit lesions of patients presenting with acute coronary syndromes.

BACKGROUND: Previous analyses suggested that vulnerable plaques and acute myocardial infarction may occur more frequently in the proximal than the distal coronary tree.

METHODS: A total of 4,234 proximal, mid, and distal 30-mm-long segments of each epicardial coronary artery were compared with each other and to the left main coronary artery (LMCA).

RESULTS: Combining IVUS data from all 3 arteries, there was a gradient in plaque burden from the proximal (42.4%) to mid (37.6%) to distal (32.6%) 30-mm-long segments (p < 0.0001). Overall, 67.4% of proximal, 41.0% of mid, and 29.7% of distal 30-mm-long segments contained at least 1 lesion (plaque burden >40%). Proportion of NC, however, was similar in the proximal and mid 30-mm-long segments of all arteries (10.3% [interquartile range (IQR): 4.8% to 16.7%] vs. 10.6% [IQR: 5.0% to 18.1%], p = 0.25), but less in the distal 30-mm-long segment (9.1% [IQR: 3.7% to 17.8%], p = 0.03 compared with the proximal segment and p = 0.003 compared with the mid segment). Overall, 17.3% of proximal, 11.5% of mid, and 9.1% of distal 30-mm-long segments had at least 1 lesion that was classified as VH-TCFA (p < 0.0001). Comparing the LMCA with the combined cohort of proximal left anterior descending, left circumflex, and right coronary artery 30-mm-long segments: 1) plaque burden was less (35.4% [IQR: 28.8% to 43.5%] vs. 40.9% [IQR: 33.3% to 48.0%], p < 0.0001); 2) fewer LMCAs contained at least 1 lesion (17.5%, p < 0.0001); 3) there was less NC (6.5% [IQR: 2.9% to 12.2%] vs. 9.3% [IQR: 4.3% to 15.9%], p < 0.0001); and 4) LMCAs rarely contained a VH-TCFA (1.8%, p < 0.0001).

CONCLUSIONS: The current analysis appears to confirm that lesions that are responsible for acute coronary events (large, plaque burden-rich in NC) are somewhat more likely to be present in the proximal than the distal coronary tree, except for the LMCA.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
22421223
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"