title: Reliability and limitations of angiography in the diagnosis of coronary plaque rupture: an intravascular ultrasound study.
abstract: OBJECTIVE
  Intravascular ultrasound (IVUS) is a cornerstone tool for the diagnosis of plaque rupture (PR) but is usually used secondary to the suspicion of PR on angiography; the true incidence of PR may therefore be overestimated. We sought to evaluate predictors of angiographic diagnosis of PR using a non-angiographically driven IVUS examination.
  
  
  RESULTS
  Diagnosis of PR on IVUS required agreement between two operators blinded to the results of angiography. Any irregular lesion with ulceration, flap or aneurysm on a qualitative angiogram was considered suspicious for PR. IVUS-detected PR and non-PR lesions were compared with the corresponding angiograms. A total of 224 distinct (ruptured or non-ruptured) lesions were detected by IVUS in 65 patients; 49 of the 105 IVUS-detected non-culprit PRs were suspected on angiography. The positive and negative predictive values for correct angiographic diagnosis of PR were 96% and 61%, respectively. Proximal coronary location, wide cavity, and counterflow rupture were strong predictors of correct angiographic diagnosis, enabling four specific angiographic patterns to be identified using three-dimensional IVUS PR reconstruction.
  
  
  CONCLUSIONS
  Against IVUS as the gold standard, angiographic diagnosis of PR showed good specificity but low sensitivity. However, better angiographic diagnosis should enable medical treatment to be optimized, especially with respect to statin therapy.
authors.affiliation: Service de cardiologie interventionnelle, Hospices Civils de Lyon, Hôpital Cardiovasculaire, Université Claude-Bernard, CREATIS UMR 5515 CNRS et INSERM Unité 886, Lyon.
authors.forename: M
authors.initials: M
authors.lastname: Gilard
authors.forename: G
authors.initials: G
authors.lastname: Rioufol
authors.forename: M
authors.initials: M
authors.lastname: Zeller
authors.forename: Y
authors.initials: Y
authors.lastname: Cottin
authors.forename: L
authors.initials: L
authors.lastname: Rochette
authors.forename: G
authors.initials: G
authors.lastname: Finet
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012421:Rupture / Q000503:physiopathology; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional