| 홍영준, 정명호, 최윤하, 마은혜, 고점석, 이민구, 박근호, 심두선, 윤남식, 윤현주, 김계훈, 박형욱, 김주한, 안영근, 조정관, 박종춘, 강정채 |
Background: An elevated high-sensitivity C-reactive protein (hs-CRP) is associated with an increased risk of future ischemic complications in acute coronary syndrome (ACS) patients.
Methods: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between hs-CRP levels and plaque components in ACS patients. VH-IVUS classified the color-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). We divided the patients into two groups according to the hs-CRP levels [≥ 0.5 mg/dl (n=58) vs. < 0.5 mg/dl (n=188)]. Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥ 10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥ 40%.
Results: Elevated hs-CRP group was more diabetics (36% vs. 16%, p<0.001), and had lower ejection fraction (59±8% vs. 63±9%, p=0.011), higher white blood cell counts (9869±3110/mm3 vs. 7906±2808/mm3, p<0.001), higher glucose (160±60 mg/dl vs. 141±45 mg/dl, p=0.029), higher fibrinogen (314±82 mg/dl vs. 275±72 mg/dl, p=0.008), and higher N-terminal pro-B-type natriuretic peptide (681±864 pg/ml vs. 213±332 pg/ml, p<0.001) and longer IVUS lesion (22±13 mm vs. 18±12 mm, p=0.020). The absolute and percent areas of NC were significantly greater in elevated hs-CRP group at the minimum lumen sites (1.40±1.16 mm2 vs. 0.89±0.73 mm2, p=0.008, and 22.1±14.2% vs. 17.0±11.4%, p=0.005, respectively) and at the largest NC sites (2.01±1.26 mm2 vs. 1.46±0.98 mm2, p=0.003, and 28.3±10.3% vs. 23.2±11.2%, p=0.002, respectively). Absolute and percent NC volumes were significantly greater in elevated hs-CRP group (25.0±17.0 mm2 vs. 15.2±10.5 mm2, p=0.001, and 20.5±12.5% vs. 15.2±8.7%, p=0.004, respectively). The presence of at least one TCFA (62% vs. 35%, p=0.006) and multiple TCFAs (26% vs. 11%, p=0.016) within culprit lesions were observed more frequently in elevated hs-CRP group.
Conclusions: VH-IVUS analysis demonstrates that ACS patients with elevated hs-CRP had more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFAs) compared with ACS patients with normal hs-CRP.
|
