Relation of ruptured plaque culprit lesion phenotype and outcomes in patients with ST elevation acute myocardial infarction

Sang Wook Kim, Young Joon Hong, Gary S. Mintz, Sung Yun Lee, Jun Hyung Doh, Seong Hoon Lim, Hyun Jae Kang, Seung-Woon Rha, Jung Sun Kim, Wang Soo Lee, Seong Jin Oh, Sahng Lee, Joo Yong Hahn, Jin Bae Lee, Jang Ho Bae, Seung Ho Hur, Seung Hwan Han, Myung Ho Jeong, Young Jo Kim

Research output: Contribution to journalArticle

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Abstract

We used virtual histology intravascular ultrasound (VH-IVUS) to assess culprit plaque rupture in 172 patients with ST-segment elevation acute myocardial infarction. VH-IVUS-defined thin-capped fibroatheroma (VH-TCFA) had necrotic core (NC) >10% of plaque area, plaque burden >40%, and NC in contact with the lumen for <3 image slices. Ruptured plaques were present in 72 patients, 61% of which were located in the proximal 30 mm of a coronary artery. Thirty-five were classified as VH-TCFA and 37 as non-VH-TCFA. Vessel size, lesion length, plaque burden, minimal lumen area, and frequency of positive remodeling were similar in VH-TCFA and non-VH-TCFA. However, the NC areas within the rupture sites of VH-TCFAs were larger compared to non-VH-TCFAs (p = 0.002), while fibrofatty plaque areas were larger in non-VH-TCFAs (p <0.0001). Ruptured plaque cavity size was correlated with distal reference lumen area (r = 0.521, p = 0.00002), minimum lumen area (r = 0.595, p <0.0001), and plaque area (r = 0.267, p = 0.033). Sensitivity and specificity curve analysis showed that a minimum lumen area of 3.5 mm 2, a distal reference lumen area of 7.5 mm 2, and a maximum NC area of 35% best predicted plaque rupture. Although VH-TCFA (35 of 72) was the most frequent phenotype of plaque rupture in ST-segment elevation myocardial infarction, plaque rupture also occurred in non-VH-TCFA: pathologic intimal thickening (8 of 72), thick-capped fibroatheroma (1 of 72), and fibrotic (14 of 72) and fibrocalcified (14 of 72) plaque. In conclusion, not all culprit plaque ruptures in patients with ST-segment elevation myocardial infarction occur as a result of TCFA rupture; a prominent fibrofatty plaque, especially in a proximal vessel, may be another form of vulnerable plaque. Further study should identify additional factors causing plaque rupture.

Original languageEnglish
Pages (from-to)794-799
Number of pages6
JournalAmerican Journal of Cardiology
Volume109
Issue number6
DOIs
Publication statusPublished - 2012 Mar 15

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Atherosclerotic Plaques
Rupture
Phenotype
Histology
Tunica Intima
ST Elevation Myocardial Infarction
Coronary Vessels
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Relation of ruptured plaque culprit lesion phenotype and outcomes in patients with ST elevation acute myocardial infarction. / Kim, Sang Wook; Hong, Young Joon; Mintz, Gary S.; Lee, Sung Yun; Doh, Jun Hyung; Lim, Seong Hoon; Kang, Hyun Jae; Rha, Seung-Woon; Kim, Jung Sun; Lee, Wang Soo; Oh, Seong Jin; Lee, Sahng; Hahn, Joo Yong; Lee, Jin Bae; Bae, Jang Ho; Hur, Seung Ho; Han, Seung Hwan; Jeong, Myung Ho; Kim, Young Jo.

In: American Journal of Cardiology, Vol. 109, No. 6, 15.03.2012, p. 794-799.

Research output: Contribution to journalArticle

Kim, SW, Hong, YJ, Mintz, GS, Lee, SY, Doh, JH, Lim, SH, Kang, HJ, Rha, S-W, Kim, JS, Lee, WS, Oh, SJ, Lee, S, Hahn, JY, Lee, JB, Bae, JH, Hur, SH, Han, SH, Jeong, MH & Kim, YJ 2012, 'Relation of ruptured plaque culprit lesion phenotype and outcomes in patients with ST elevation acute myocardial infarction', American Journal of Cardiology, vol. 109, no. 6, pp. 794-799. https://doi.org/10.1016/j.amjcard.2011.10.042
Kim, Sang Wook ; Hong, Young Joon ; Mintz, Gary S. ; Lee, Sung Yun ; Doh, Jun Hyung ; Lim, Seong Hoon ; Kang, Hyun Jae ; Rha, Seung-Woon ; Kim, Jung Sun ; Lee, Wang Soo ; Oh, Seong Jin ; Lee, Sahng ; Hahn, Joo Yong ; Lee, Jin Bae ; Bae, Jang Ho ; Hur, Seung Ho ; Han, Seung Hwan ; Jeong, Myung Ho ; Kim, Young Jo. / Relation of ruptured plaque culprit lesion phenotype and outcomes in patients with ST elevation acute myocardial infarction. In: American Journal of Cardiology. 2012 ; Vol. 109, No. 6. pp. 794-799.
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AU - Doh, Jun Hyung

AU - Lim, Seong Hoon

AU - Kang, Hyun Jae

AU - Rha, Seung-Woon

AU - Kim, Jung Sun

AU - Lee, Wang Soo

AU - Oh, Seong Jin

AU - Lee, Sahng

AU - Hahn, Joo Yong

AU - Lee, Jin Bae

AU - Bae, Jang Ho

AU - Hur, Seung Ho

AU - Han, Seung Hwan

AU - Jeong, Myung Ho

AU - Kim, Young Jo

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N2 - We used virtual histology intravascular ultrasound (VH-IVUS) to assess culprit plaque rupture in 172 patients with ST-segment elevation acute myocardial infarction. VH-IVUS-defined thin-capped fibroatheroma (VH-TCFA) had necrotic core (NC) >10% of plaque area, plaque burden >40%, and NC in contact with the lumen for <3 image slices. Ruptured plaques were present in 72 patients, 61% of which were located in the proximal 30 mm of a coronary artery. Thirty-five were classified as VH-TCFA and 37 as non-VH-TCFA. Vessel size, lesion length, plaque burden, minimal lumen area, and frequency of positive remodeling were similar in VH-TCFA and non-VH-TCFA. However, the NC areas within the rupture sites of VH-TCFAs were larger compared to non-VH-TCFAs (p = 0.002), while fibrofatty plaque areas were larger in non-VH-TCFAs (p <0.0001). Ruptured plaque cavity size was correlated with distal reference lumen area (r = 0.521, p = 0.00002), minimum lumen area (r = 0.595, p <0.0001), and plaque area (r = 0.267, p = 0.033). Sensitivity and specificity curve analysis showed that a minimum lumen area of 3.5 mm 2, a distal reference lumen area of 7.5 mm 2, and a maximum NC area of 35% best predicted plaque rupture. Although VH-TCFA (35 of 72) was the most frequent phenotype of plaque rupture in ST-segment elevation myocardial infarction, plaque rupture also occurred in non-VH-TCFA: pathologic intimal thickening (8 of 72), thick-capped fibroatheroma (1 of 72), and fibrotic (14 of 72) and fibrocalcified (14 of 72) plaque. In conclusion, not all culprit plaque ruptures in patients with ST-segment elevation myocardial infarction occur as a result of TCFA rupture; a prominent fibrofatty plaque, especially in a proximal vessel, may be another form of vulnerable plaque. Further study should identify additional factors causing plaque rupture.

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