Impact of plaque composition on long-term clinical outcomes in patients with coronary artery occlusive disease

• Published in: Korean circulation journal Vol. 43; no. 6; pp. 377 - 383
• Main Authors: Kim, Ki Hong, Kim, Wan Ho, Park, Hyun Woong, Song, In Girl, Yang, Dong Ju, Seo, Young Hoon, Yuk, Hyung Bin, Park, Yo Han, Kwon, Taek Geun, Rihal, Charanjit S, Lerman, Amir, Lee, Moo-Sik, Bae, Jang-Ho
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Cardiology 01-06-2013; 대한심장학회
• Subjects: Original; 내과학; Coronary artery disease; Intravascular ultrasonography; Plaque, atherosclerotic
• ISSN: 1738-5520; 1738-5555
• DOI: 10.4070/kcj.2013.43.6.377

It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients.
The study subjects consisted of 339 consecutive patients (mean 61.7±12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period.
Patients with high fibrofatty volume (FFV, >8.90 mm(3), n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV≤8.90 mm(3), n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE.
FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.