title: Incidence and predictors of plaque rupture in the peripheral arteries.
abstract: BACKGROUND
  Plaque rupture may be present in the peripheral arteries of the patients at high risk for cardiovascular events and is possibly associated with vascular vulnerability.
  
  
  RESULTS
  One hundred one iliofemoral arteries from 101 patients undergoing angioplasty were studied. Intravascular ultrasound imaging was performed before intervention. Plaque rupture was defined as presence of a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Incidence, numbers, and location of the plaque rupture were investigated. Plaque rupture was found in 42 of 101 arteries (42%). Patients with plaque rupture had significantly higher prevalence of acute coronary syndrome than did patients without plaque rupture (42% vs 16%, P=0.01). By multivariable logistic regression analysis, acute coronary syndrome (P=0.004) and male sex (P=0.01) were independent clinical correlates of plaque rupture. During follow-up (median, 14.7 months), the incidence of major adverse cardiac or cerebrovascular events (death, myocardial infarction, and ischemic stroke) was similar between the 2 groups. The incidence of major adverse cardiac or cerebrovascular events plus peripheral vascular events (unplanned vascular intervention and amputation) was significantly higher in patients with plaque rupture than in patients without plaque rupture (46% vs 21%, P=0.008). By multivariable Cox regression analysis, plaque rupture (hazard ratio=2.80, 95% CI: 1.23 to 6.37, P=0.01) and Fontaine stage IV (hazard ratio=3.50, 95% CI: 1.58 to 7.71, P=0.002) were independent predictors of major adverse cardiac or cerebrovascular events plus peripheral vascular events.
  
  
  CONCLUSIONS
  Ruptured plaque of the iliofemoral arteries is a common finding. Patients with plaque rupture had a higher prevalence of history of acute coronary syndrome and lower major adverse cardiac or cerebrovascular events plus peripheral vascular event-free survival.
authors.affiliation: Bell Land General Hospital, Sakai, Japan. hokura@fides.dti.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Asawa
authors.forename: Tomoichiro
authors.initials: T
authors.lastname: Kubo
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Taguchi
authors.forename: Iku
authors.initials: I
authors.lastname: Toda
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D004108:Dilatation, Pathologic; D018450:Disease Progression; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D015995:Prevalence; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D012737:Sex Factors; D018084:Ultrasonography, Interventional