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Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome
OBJECTIVES To determine the morphologic features of coronary plaques associated with acute coronary syndrome, we prospectively followed patients with atherosclerotic disease identified by intravascular ultrasound (IVUS). BACKGROUND Although clinical evaluation of the vulnerable atherosclerotic plaqu...
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| Published in: | Journal of the American College of Cardiology 2000-01, Vol.35 (1), p.106-111 |
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| container_title | Journal of the American College of Cardiology |
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| creator | Yamagishi, Masakazu Terashima, Mitsuyasu Awano, Kojiro Kijima, Mikihiro Nakatani, Satoshi Daikoku, Satoshi Ito, Kenichi Yasumura, Yoshio Miyatake, Kunio |
| description | OBJECTIVES
To determine the morphologic features of coronary plaques associated with acute coronary syndrome, we prospectively followed patients with atherosclerotic disease identified by intravascular ultrasound (IVUS).
BACKGROUND
Although clinical evaluation of the vulnerable atherosclerotic plaque is important, few data exist regarding the morphology of the vulnerable plaque in clinical settings.
METHODS
We examined 114 coronary sites without significant stenosis by angiography ( |
| doi_str_mv | 10.1016/S0735-1097(99)00533-1 |
| format | article |
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To determine the morphologic features of coronary plaques associated with acute coronary syndrome, we prospectively followed patients with atherosclerotic disease identified by intravascular ultrasound (IVUS).
BACKGROUND
Although clinical evaluation of the vulnerable atherosclerotic plaque is important, few data exist regarding the morphology of the vulnerable plaque in clinical settings.
METHODS
We examined 114 coronary sites without significant stenosis by angiography (<50% diameter stenosis) in 106 patients. All the sites exhibited atherosclerotic lesions by IVUS. These lesions consisted of 22 concentric and 92 eccentric plaques with a percent plaque area averaging 59 ± 12%.
RESULTS
During the follow-up period of 21.8 ± 6.4 months (range 1 to 24), 12 patients had an acute coronary event at a previously examined coronary site at an average of 4.0 ± 3.4 months after the initial IVUS study. All the preexisting plaques related to the acute events exhibited an eccentric pattern and the mean percent plaque area was 67 ± 9%, which was greater than plaque area in the other 90 patients without acute events (57 ± 12%, p < 0.05). There was no statistically significant difference in lumen area between two patient groups (6.7 ± 3.0 vs. 7.5 ± 3.7 mm2). Among 12 coronary sites with an acute occlusion, 10 sites contained the echolucent zones, eight of these shallow and two deep, likely representing a lipid-rich core. In 90 sites without acute events, an echolucent zone in the shallow portion was seen at only four sites (p < 0.05).
CONCLUSIONS
Large eccentric plaque containing an echolucent zone by IVUS can be at increased risk for instability even though the lumen area is preserved at the time of initial study. Compensatory enlargement of vessel wall due to remodeling may contribute to the relatively small degree of stenosis by angiography.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(99)00533-1</identifier><identifier>PMID: 10636267</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Angina Pectoris - diagnostic imaging ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Coronary Artery Disease - diagnostic imaging ; Coronary Vessels - diagnostic imaging ; Endosonography ; Female ; Follow-Up Studies ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnostic imaging ; Observer Variation ; Predictive Value of Tests ; Prospective Studies ; Risk Factors</subject><ispartof>Journal of the American College of Cardiology, 2000-01, Vol.35 (1), p.106-111</ispartof><rights>2000 American College of Cardiology</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c589t-24d0d84cb9129a0dffd7c3aadfb1d880328524677a29ea16357ec57126f295033</citedby><cites>FETCH-LOGICAL-c589t-24d0d84cb9129a0dffd7c3aadfb1d880328524677a29ea16357ec57126f295033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4009,27902,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1235742$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10636267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamagishi, Masakazu</creatorcontrib><creatorcontrib>Terashima, Mitsuyasu</creatorcontrib><creatorcontrib>Awano, Kojiro</creatorcontrib><creatorcontrib>Kijima, Mikihiro</creatorcontrib><creatorcontrib>Nakatani, Satoshi</creatorcontrib><creatorcontrib>Daikoku, Satoshi</creatorcontrib><creatorcontrib>Ito, Kenichi</creatorcontrib><creatorcontrib>Yasumura, Yoshio</creatorcontrib><creatorcontrib>Miyatake, Kunio</creatorcontrib><title>Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
To determine the morphologic features of coronary plaques associated with acute coronary syndrome, we prospectively followed patients with atherosclerotic disease identified by intravascular ultrasound (IVUS).
BACKGROUND
Although clinical evaluation of the vulnerable atherosclerotic plaque is important, few data exist regarding the morphology of the vulnerable plaque in clinical settings.
METHODS
We examined 114 coronary sites without significant stenosis by angiography (<50% diameter stenosis) in 106 patients. All the sites exhibited atherosclerotic lesions by IVUS. These lesions consisted of 22 concentric and 92 eccentric plaques with a percent plaque area averaging 59 ± 12%.
RESULTS
During the follow-up period of 21.8 ± 6.4 months (range 1 to 24), 12 patients had an acute coronary event at a previously examined coronary site at an average of 4.0 ± 3.4 months after the initial IVUS study. All the preexisting plaques related to the acute events exhibited an eccentric pattern and the mean percent plaque area was 67 ± 9%, which was greater than plaque area in the other 90 patients without acute events (57 ± 12%, p < 0.05). There was no statistically significant difference in lumen area between two patient groups (6.7 ± 3.0 vs. 7.5 ± 3.7 mm2). Among 12 coronary sites with an acute occlusion, 10 sites contained the echolucent zones, eight of these shallow and two deep, likely representing a lipid-rich core. In 90 sites without acute events, an echolucent zone in the shallow portion was seen at only four sites (p < 0.05).
CONCLUSIONS
Large eccentric plaque containing an echolucent zone by IVUS can be at increased risk for instability even though the lumen area is preserved at the time of initial study. Compensatory enlargement of vessel wall due to remodeling may contribute to the relatively small degree of stenosis by angiography.</description><subject>Angina Pectoris - diagnostic imaging</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Endosonography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Observer Variation</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNqFkctu1DAUhi0EotPCI4C8QKgsAr7EcdwNQhU3qYgFsLYc-7g1cuJgJwPzHjwwns4IumNlWef7z-X_EXpCyUtKaPfqC5FcNJQoea7UC0IE5w29hzZUiL7hQsn7aPMXOUGnpXwnhHQ9VQ_RCSUd71gnN-j3p5TnmxTT9Q4nj7drnCCbIQK2KafJ5B2eo_mxwgUOUwnXN0vBPqcR-xRj-tms8142myXAVEvwy4xhAoeHXeWXbLam2DWajNdYfyWtU62BTxmwmbCx63JnUtlNrvaGR-iBN7HA4-N7hr69e_v18kNz9fn9x8s3V40VvVoa1jri-tYOijJliPPeScuNcX6gru8JZ71gbSelYQoM7biQYIWkrPNMCcL5GXp-6DvnVE8six5DsRCjmSCtRUvSd4LItoLiANqcSsng9ZzDWFfWlOh9HPo2Dr33Wiulb-PQtOqeHgeswwjujurgfwWeHYHqk4k-m8mG8o9jdeeWVez1AYPqxjZA1sVWwy24kMEu2qXwn03-ADYqqrQ</recordid><startdate>200001</startdate><enddate>200001</enddate><creator>Yamagishi, Masakazu</creator><creator>Terashima, Mitsuyasu</creator><creator>Awano, Kojiro</creator><creator>Kijima, Mikihiro</creator><creator>Nakatani, Satoshi</creator><creator>Daikoku, Satoshi</creator><creator>Ito, Kenichi</creator><creator>Yasumura, Yoshio</creator><creator>Miyatake, Kunio</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200001</creationdate><title>Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome</title><author>Yamagishi, Masakazu ; Terashima, Mitsuyasu ; Awano, Kojiro ; Kijima, Mikihiro ; Nakatani, Satoshi ; Daikoku, Satoshi ; Ito, Kenichi ; Yasumura, Yoshio ; Miyatake, Kunio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c589t-24d0d84cb9129a0dffd7c3aadfb1d880328524677a29ea16357ec57126f295033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Angina Pectoris - diagnostic imaging</topic><topic>Atherosclerosis (general aspects, experimental research)</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Endosonography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Observer Variation</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamagishi, Masakazu</creatorcontrib><creatorcontrib>Terashima, Mitsuyasu</creatorcontrib><creatorcontrib>Awano, Kojiro</creatorcontrib><creatorcontrib>Kijima, Mikihiro</creatorcontrib><creatorcontrib>Nakatani, Satoshi</creatorcontrib><creatorcontrib>Daikoku, Satoshi</creatorcontrib><creatorcontrib>Ito, Kenichi</creatorcontrib><creatorcontrib>Yasumura, Yoshio</creatorcontrib><creatorcontrib>Miyatake, Kunio</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamagishi, Masakazu</au><au>Terashima, Mitsuyasu</au><au>Awano, Kojiro</au><au>Kijima, Mikihiro</au><au>Nakatani, Satoshi</au><au>Daikoku, Satoshi</au><au>Ito, Kenichi</au><au>Yasumura, Yoshio</au><au>Miyatake, Kunio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2000-01</date><risdate>2000</risdate><volume>35</volume><issue>1</issue><spage>106</spage><epage>111</epage><pages>106-111</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
To determine the morphologic features of coronary plaques associated with acute coronary syndrome, we prospectively followed patients with atherosclerotic disease identified by intravascular ultrasound (IVUS).
BACKGROUND
Although clinical evaluation of the vulnerable atherosclerotic plaque is important, few data exist regarding the morphology of the vulnerable plaque in clinical settings.
METHODS
We examined 114 coronary sites without significant stenosis by angiography (<50% diameter stenosis) in 106 patients. All the sites exhibited atherosclerotic lesions by IVUS. These lesions consisted of 22 concentric and 92 eccentric plaques with a percent plaque area averaging 59 ± 12%.
RESULTS
During the follow-up period of 21.8 ± 6.4 months (range 1 to 24), 12 patients had an acute coronary event at a previously examined coronary site at an average of 4.0 ± 3.4 months after the initial IVUS study. All the preexisting plaques related to the acute events exhibited an eccentric pattern and the mean percent plaque area was 67 ± 9%, which was greater than plaque area in the other 90 patients without acute events (57 ± 12%, p < 0.05). There was no statistically significant difference in lumen area between two patient groups (6.7 ± 3.0 vs. 7.5 ± 3.7 mm2). Among 12 coronary sites with an acute occlusion, 10 sites contained the echolucent zones, eight of these shallow and two deep, likely representing a lipid-rich core. In 90 sites without acute events, an echolucent zone in the shallow portion was seen at only four sites (p < 0.05).
CONCLUSIONS
Large eccentric plaque containing an echolucent zone by IVUS can be at increased risk for instability even though the lumen area is preserved at the time of initial study. Compensatory enlargement of vessel wall due to remodeling may contribute to the relatively small degree of stenosis by angiography.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10636267</pmid><doi>10.1016/S0735-1097(99)00533-1</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 0735-1097 1558-3597 |
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| subjects | Angina Pectoris - diagnostic imaging Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Coronary Artery Disease - diagnostic imaging Coronary Vessels - diagnostic imaging Endosonography Female Follow-Up Studies Humans Male Medical sciences Middle Aged Myocardial Infarction - diagnostic imaging Observer Variation Predictive Value of Tests Prospective Studies Risk Factors |
| title | Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome |
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