Multiple plaque rupture and C-reactive protein in acute myocardial infarction.
OBJECTIVE
This study sought to investigate the relationship between multiple plaque ruptures, C-reactive protein (CRP), and clinical prognosis in acute myocardial infarction (AMI).


BACKGROUND
Several studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients. Recent studies have reported that a ruptured plaque at the culprit lesion is associated with elevated CRP, which indicates a poor prognosis in patients with ACS.


METHODS
We performed intravascular ultrasound in 45 infarct-related arteries and another 84 major coronary arteries in 45 first AMI patients.


RESULTS
Plaque rupture was observed in 21 patients (47%) at the culprit site. Intravascular ultrasound revealed 17 additional plaque ruptures at remote sites in 11 patients (24%). Patients with multiple risk factors were more frequently found in our multiple-plaque rupture patients compared with single-plaque rupture or nonrupture patients (82% vs. 40% vs. 29%, p = 0.01). High-sensitive CRP levels had a positive correlation with the number of plaque ruptures (p < 0.01). All culprit lesions were successfully treated by percutaneous coronary intervention. Patients with multiple plaque rupture showed significantly poor prognosis compared with others (p = 0.01).


CONCLUSIONS
Multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Our results suggest that AMI treatment should focus not only on stabilization of the culprit site but also a systemic approach to systemic stabilization of the arteries.
Tanaka
Atsushi
A
Department of Cardiology, Baba Memorial Hospital, Sakai, Japan. m4497147@msic.med.osaka-cu.ac.jp
Shimada
Kenei
K
Sano
Toshihiko
T
Namba
Masashi
M
Sakamoto
Tsunemori
T
Nishida
Yukio
Y
Kawarabayashi
Takahiko
T
Fukuda
Daiju
D
Yoshikawa
Junichi
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000276:immunology* / Q000628:therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000276:immunology* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000276:immunology* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D018746:Systemic Inflammatory Response Syndrome / Q000000981:diagnostic imaging / Q000276:immunology / Q000628:therapy; D014463:Ultrasonography
D002097:C-Reactive Protein