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Relation of Ruptured Plaque Culprit Lesion Phenotype and Outcomes in Patients With ST Elevation Acute Myocardial Infarction

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Author(s)
Sang Wook KimYoung Joon HongGary S. MintzSung Yun LeeJun Hyung DohSeong Hoon LimHyun Jae KangSeung Woon RhaJung Sun KimWang-Soo LeeSeong Jin OhSahng LeeJoo Yong HahnJin Bae LeeJang Ho BaeSeung Ho HurSeung Hwan HanMyung Ho JeongYoung Jo Kim
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
American Journal of Cardiology
Issued Date
2012
Volume
109
Issue
6
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-IVUSdefined
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-VHTCFA.
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 mm2,
a distal reference lumen area of 7.5 mm2, 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. © 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:
794–799)
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine
Citation
Sang Wook Kim et al. (2012). Relation of Ruptured Plaque Culprit Lesion Phenotype and Outcomes in Patients With ST Elevation Acute Myocardial Infarction. American Journal of Cardiology, 109(6), 794–799. doi: 10.1016/j.amjcard.2011.10.042
Type
Article
ISSN
0002-9149
Source
https://linkinghub.elsevier.com/retrieve/pii/S000291491103373X
DOI
10.1016/j.amjcard.2011.10.042
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/34897
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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