title: Necrotic core and its ratio to dense calcium are predictors of high-risk non-ST-elevation acute coronary syndrome.
abstract: Increased creatine kinase-MB levels and ST-segment depression are well-known prognostic factors in the setting of non-ST-elevation acute coronary syndrome (ACS). We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these prognostic factors. We performed "whole vessel" VH-IVUS analysis in culprit arteries of 225 patients with ACS and measured the 4 basic VH-IVUS coronary plaque components--fibrous, fibrofatty, dense calcium (DC), and necrotic core (NC)--and calculated a NC/DC ratio. Patients' age was 62 +/- 11 years; 72% were men and 23% had diabetes. Only the NC/DC ratio had a positive association with creatine kinase-MB levels (r = 0.21, p = 0.03), and it was significantly higher for patients with ST-depression compared with those with non-ST-depression ACS (1.97 +/- 1.46 vs 1.58 +/- 1.10, p = 0.02). Sensitivity and specificity curves determined that a NC/DC value > or =2 (odds ratio 3.8, p = 0.01) and percentage of NC > or =6 (odds ratio 3.1, p = 0.04) were thresholds that best separated patients with high-risk non-ST-elevation ACS from those without abnormal creatine kinase-MB or ST depression. Patients with both predictors had significantly higher total cholesterol (204.7 +/- 60.5 vs 173.6 +/- 44.3 mg/dl, p = 0.01), higher low-density liprotein cholesterol (132.5 +/- 49.8 vs 101.3 +/- 33.2 mg/dl, p = 0.02), and more myocardial injury (creatine kinase-MB value of 42 +/- 38 vs 12 +/- 21, p = 0.01) than patients with no predictors. In conclusion, VH-IVUS analysis showed that the percentage of NC and its ratio to DC in diseased coronary segments are positively associated with a high-risk ACS presentation.
authors.affiliation: Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Missel
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Stephane G
authors.initials: SG
authors.lastname: Carlier
authors.forename: Koichi
authors.initials: K
authors.lastname: Sano
authors.forename: Jie
authors.initials: J
authors.lastname: Qian
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Kaple
authors.forename: Celia
authors.initials: C
authors.lastname: Castellanos
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000473:pathology*; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012907:Smoking / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D003402:Creatine Kinase