title: Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans.
abstract: OBJECTIVE
  Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes.
  
  
  RESULTS
  In 51 consecutive patients (45 men), aged 38-76 years (mean age: 58+/-10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data (IVUS-Virtual Histology). The study vessel was the left anterior descending artery in 23 (45%) patients; the circumflex artery in nine (18%), and right coronary artery in 19 (37%). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5+/-13 mm long (range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first (median: 8.75%; IQR: 5.7-18) vs. the third (median: 6.1%; IQR: 3.2-12) (P=0.036) and fourth (median: 4.5%; IQR: 2.4-7.9) (P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [beta=-0.28 (95%CI: -0.15, -0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus.
  
  
  CONCLUSIONS
  Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.
authors.affiliation: Erasmus Medical Center, Thoraxcenter Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Gastón A
authors.initials: GA
authors.lastname: Rodriguez-Granillo
authors.forename: Héctor M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malagutti
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D008055:Lipids