In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry.
OBJECTIVE
We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and risk factors histopathologically associated with sudden coronary death (SCD) in men: cigarette smoking and an increased total cholesterol-to-high-density lipoprotein cholesterol (HDL-C) ratio (TC/HDL > 5).


RESULTS
We assessed volumetric VH-IVUS parameters in a consecutive series of 473 male patients: fibrous, fibro-fatty, dense calcium (DC), necrotic core (NC), and a calculated NC/DC ratio. Patients' age was 61 ± 11 years, with 27% smokers and 69% having a lipid disorder. The NC/DC ratio was the only VH-IVUS parameter related to both TC/HDL ratio (r = 0.18, P= 0.0008) and low-density lipoprotein cholesterol levels (r = 0.17, P= 0.002); had a negative correlation with HDL-C levels (r = -0.11, P= 0.03); and was higher for smokers [median 1.98 (1.35-3.18)] vs. non-smokers [median 1.70 (1.23-2.53), P= 0.006]. An NC/DC value >3 was the threshold that best identified smokers and/or patients presenting TC/HDL >5 (odds ratio 3.0, 95% CI 1.7-4.9, P= 0.0001), and receiver-operator curves showed the superiority of the NC/DC ratio [area under curve (AUC) 0.64, P < 0.0001] over %DC (AUC 0.58, P= 0.006) or %NC (AUC 0.51, P= 0.43) to identify these patients.


CONCLUSIONS
The ratio of NC to calcification detected by VH-IVUS in diseased coronary segments is related to known risk factors for SCD and, thus, may be associated with a worse prognosis.
Missel
Eduardo
E
Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA.
Mintz
Gary S
GS
Carlier
Stephane G
SG
Qian
Jie
J
Shan
Shoujie
S
Castellanos
Celia
C
Kaple
Ryan
R
Biro
Sinan
S
Fahy
Martin
M
Moses
Jeffrey W
JW
Stone
Gregg W
GW
Leon
Martin B
MB
D000368:Aged; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000473:pathology*; D050171:Dyslipidemias / Q000097:blood / Q000473:pathology; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D018084:Ultrasonography, Interventional
D008055:Lipids