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Abstract
106 Which virtual histology intravascular ultrasound properties discriminate better between stable angina pectoris and troponin positive acute coronary syndrome: assessment of plaques or analysis of the whole coronary artery vasculature?
  1. P A Calvert1,
  2. D R Obaid1,
  3. N E J West2,
  4. L M Shapiro2,
  5. D McNab2,
  6. C G Densem2,
  7. P M Schofield2,
  8. D Braganza2,
  9. S C Clarke2,
  10. M O'Sullivan2,
  11. K R Ray3,
  12. M R Bennett1
  1. 1Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
  2. 2Papworth Hospital NHS Foundation Trust, Cambridge, UK
  3. 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

Abstract

Introduction Previous work has examined the relationship between plaque virtual-histology intravascular ultrasound (VH-IVUS) appearances (local coronary factors) and patient presentation. However, little is known about the relationship between patient presentation and VH-IVUS appearances of the whole coronary vascular tree (global coronary factors), which may be a better ‘barometer’ of patients' cardiovascular risk. This study aims to determine which VH-IVUS coronary factors, local or global, discriminate better between stable angina and troponin-positive acute coronary syndrome (ACS).

Methods This 200 patient cross-sectional study examined the VH-IVUS appearances of the whole coronary vascular tree (full 3-vessel VH-IVUS) in patients referred for percutaneous coronary intervention (PCI) with either stable angina or ACS. VH-IVUS imaging preceded PCI. Results are presented as mean±SD unless stated.

Results There were no differences in baseline demographics between stable angina and ACS groups including age, sex, blood pressure, previous MI, diabetes, serum cholesterol/HDL ratio and smoking. On full 3-vessel VH-IVUS, diabetic patients had a greater necrotic core volume (238±168 mm3 vs 120±77 mm3, p=0.022) and plaque burden (1673±645 mm3 vs 1102±445 mm3, p=0.006) than non-diabetics. After adjusting for total plaque volume, diabetics still had more necrotic core volume than non-diabetics: 12.9±5.0% vs 10.3±4.1%, p=0.045. Full 3-vessel VH-IVUS necrotic core volume did not differ between stable angina and ACS groups, even after adjusting for total plaque volume: 10.1±4.0% vs 11.6±4.6%, p=0.10, indicating that plaque composition throughout the whole arterial tree could not predict presentation. However, ACS patients were more likely to have at least one VH-IVUS derived thin-capped fibroatheroma (ID-TCFA) in the target vessel than stable angina patients: OR 2.2 (95% CI 0.9 to 5.4), p=0.048. Abstract 106 Figure 1 shows ID-TCFA (FI=fibrous tissue, FF=fibrofatty tissue, NC=necrotic core, DC=dense calcium).

Conclusion Although global coronary factors (whole coronary artery plaque burden and necrotic core volume) may define high-risk patient populations such as diabetics, local plaque structure such as presence of ID-TCFAs in the target vessel may be more important in governing mode of patient presentation.

  • vulnerable plaque
  • necrotic core
  • virtual histology

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