Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: a three-vessel intravascular ultrasound study in 235 patients.
BACKGROUND
We evaluated the incidence and predictors of single and multiple plaque ruptures in acute myocardial infarction (AMI) and stable angina pectoris (SAP).


RESULTS
We performed 3-vessel intravascular ultrasound (IVUS) examination in 235 patients: 122 had AMI, and 113 had SAP. Plaque rupture of infarct-related or target lesions occurred in 80 AMI patients (66%) and in 31 SAP patients (27%) (P<0.001). Non-infarct-related or non-target artery plaque ruptures occurred in 21 AMI patients (17%) and 6 SAP patients (5%) (P=0.008). Multiple plaque ruptures were observed in 24 AMI (20%) and 7 SAP patients (6%) (P=0.004). Therefore, at least 1 plaque rupture in any coronary artery was noted in 84 AMI patients (69%) and 35 SAP patients (31%) (P<0.001). Overall, the only independent clinical predictor of plaque rupture in the infarct-related/target lesion was AMI (P<0.01; OR, 4.867; 95% CI, 2.734 to 8.661). The only independent clinical predictor of plaque rupture in AMI patients was an elevated C-reactive protein (CRP) level (P=0.035; OR, 2.139; 95% CI, 1.053 to 4.343). Conversely, in SAP patients, the only independent clinical predictor of plaque rupture was diabetes mellitus (P=0.034; OR, 2.553; 95% CI, 1.071 to 6.085). The only independent clinical predictor of multiple plaque ruptures was AMI (P=0.003; OR, 3.752; 95% CI, 1.546 to 9.105).


CONCLUSIONS
Three-vessel IVUS imaging showed that culprit lesion plaque rupture, secondary remote plaque ruptures, and multiple plaque ruptures were all more common in AMI patients than SAP patients. In AMI patients, plaque rupture was associated with a high CRP level, whereas in SAP patients, plaque rupture was more common in those with diabetes.
Hong
Myeong-Ki
MK
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Mintz
Gary S
GS
Lee
Cheol Whan
CW
Kim
Young-Hak
YH
Lee
Seung-Whan
SW
Song
Jong-Min
JM
Han
Ki-Hoon
KH
Kang
Duk-Hyun
DH
Song
Jae-Kwan
JK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D006328:Cardiac Catheterization; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D018084:Ultrasonography, Interventional
D015415:Biomarkers; D002097:C-Reactive Protein