Heart 1999;81:621-627 ( June )

Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound

J Ge^a, F Chirillo^b, J Schwedtmann^a, G Görge^a, M Haude^a, D Baumgart^a, V Shah^a, C von Birgelen^a, S Sack^a, H Boudoulas^c, R Erbel^a

^a Department of Cardiology, University Essen, Hufelandstr 55, 45122 Essen, Germany, ^b Department of Cardiology, Regional Hospital Treviso, Italy, ^c Division of Cardiology, Ohio State University, Ohio, USA

Correspondence to: Dr Ge.

Accepted for publication 15 December 1998

AIMTo visualise the characteristics of ruptured plaques by intravascular ultrasound (IVUS) and to correlate plaque characteristics with clinical symptoms to establish a quantitative index of plaque vulnerability.
METHODS144 consecutive patients with angina were examined using IVUS. Ruptured plaques, characterised by a plaque cavity and a tear on the thin fibrous cap, were identified in 31 patients (group A), of whom 23 (74%) presented with unstable angina. Plaque rupture was confirmed by injecting contrast medium filling the plaque cavity during IVUS examination. Of the patients without plaque rupture (group B, n = 108), only 19 (18%) had unstable angina.
RESULTSNo significant differences were found between groups A and B in relation to plaque and vessel area (p > 0.05). Mean (SD) per cent stenosis in group A was less than in group B, at 56.2 (16.5)% v 67.9 (13.4)%; p < 0.001. Area of the emptied plaque cavity in group A (4.1 (3.2) mm²) was larger than the echolucent zone in group B (1.32 (0.79) mm²) (p < 0.001). The plaque cavity to plaque ratio in group A (38.5 (17.1)%) was larger than the echolucent area to plaque ratio in group B (11.2 (8.9)%) (p < 0.001). The thickness of the fibrous cap in group A was less than in group B, at 0.47 (0.20) mm v 0.96 (0.94) mm; p < 0.001.
CONCLUSIONSPlaques seem to be prone to rupture when the echolucent area is larger than 4.1 (3.2) mm², when the echolucent area to plaque ratio is greater than 38.5 (17.1)%, and when the fibrous cap is thinner than 0.7 mm. IVUS can identify plaque rupture and vulnerable plaques. This may influence patient management and treatment.


Keywords: intravascular ultrasound; atherosclerosis; unstable angina; myocardial infarction; plaque rupture

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© 1999 by Heart
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