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ȣ - 530134 349 |
| Thin-Capped Fibroatheroma in Left Main Coronary Artery (LMCA) and non-LMCA; A Virtual Histology Intravascular Ultrasound Analysis |
| 중앙대학교병원 순환기내과 심장혈관센터¹ , Cardiovascular Research Foundation² , Washington Hospital Center³ |
| 김상욱, 권지은, Gary S. Mintz² , 이왕수, 조영미, 서재승, 이광제, 최주원, 홍준화, 김태호, 김치정, 조대윤, Neil J. Weissman³, 류왕성 |
We assessed Virtual Histology Intravascular Ultrasound (VH-IVUS) thin-capped fibroatheroma (VH-TCFA) in the left main coronary artery (LM, in 210 pts) vs 201 non-LM arteries. VH-TCFA was defined as necrotic core (NC) >10% of plaque area with a plaque burden of >40% and NC in contact with the lumen for ≥3 image slices. Positive remodeling was a remodeling index (lesion/reference EEM [external elastic membrane] area) >1.05. Results. Pt age was 63±12yrs and 33% were diabetics in LM-TCFA; pt age was 64±11yrs and 16% were diabetics in non-LM-TCFA. Acute coronary syndrome was present in 32 pts with non-LM TCFA vs 19 pts with LM-TCFA. The frequency of TCFA was lower in LM: 10% (21/210) vs 20% (40/201) of non-LM TCFA (p=0.0008). Non-LM TCFA were located in 14 LAD, 5 LCX, and 21 RCA; 70% (28/40) were located in proximal 30mm of each coronary artery. Vessel size was larger in LM-TCFA (p<0.0001), however, non-LM TCFA had a larger plaque burden (p<0.0001, Table). Additionally, non-LM TCFA showed more positive remodeling (p=0.0314): 9.5% (2/21) in LM-TCFA vs 48% (14/29) in non-LM TCFA (p=0.0037). Finally, %maximal NC (p=0.0121) and %maximal dense calcium (p=0.0503) were larger in non-LM TCFA vs LM-TCFA (Table). Conclusion. Non-LM TCFA may be more vulnerable than in LM-TCFA because of a greater % necrotic core as well as larger plaque burden.
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LM-TCFA
(n=21) |
Non-LM TCFA
(n=40) |
p-value |
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distal reference lumen area(mm2) |
13.5±4.37 |
7.69±2.98 |
<0.0001 |
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Minimal lumen area (mm2) |
11.51±4.06 |
3.52±1.47 |
<0.0001 |
|
Lumen area (max.NC site, mm2) |
12.91±3.7 |
6.34±2.46 |
<0.0001 |
|
Plaque burden (max.NC site, %) |
49.28±8.75 |
64.39±9.23 |
<0.0001 |
|
Remodeling index |
0.99±0.1 |
1.1±0.23 |
0.0314 |
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Maximal fibrotic area (%) |
72.2±14.57 |
83.61±6.77 |
0.0024 |
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Maximal fibrofatty area (%) |
12.7±8.2 |
15.78±7.62 |
0.1683 |
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Maximal necrotic core area (%) |
29.66±9.23 |
36.9±10.34 |
0.0121 |
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Maximal dense calcium (%) |
19±8.13 |
24.42±10.47 |
0.0503 |
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