title: Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction.
abstract: The aim of this study was to assess the association between the spatial location of plaque rupture and remodeling pattern of culprit lesions in acute anterior myocardial infarction (MI). Positive remodeling suggests a potential surrogate marker of plaque vulnerability, whereas plaque rupture causes thrombus formation followed by coronary occlusion and MI. Intravascular ultrasound (IVUS) can determine the precise spatial orientation of coronary plaque formation. We studied 52 consecutive patients with acute anterior MI caused by plaque rupture of the culprit lesion as assessed by preintervention IVUS. The plaques were divided into those with and without positive remodeling. We divided the plaques into three categories according to the spatial orientation of plaque rupture site: myocardial (inner curve), epicardial (outer curve), and lateral quadrants (2 intermediate quadrants). Among 52 plaque ruptures in 52 lesions, 27 ruptures were oriented toward the epicardial side (52%), 18 toward the myocardial side (35%), and 7 in the 2 lateral quadrants (13%). Among 35 plaques with positive remodeling, plaque rupture was observed in 21 (52%) on the epicardial side, 12 (34%) on the myocardial side, and 2 (6%) on the lateral side. However, among 17 plaques without positive remodeling, plaque rupture was observed in 6 (35%), 6 (35%), and 5 (30%), respectively (p = 0.047). Atherosclerotic plaques with positive remodeling showed more frequent plaque rupture on the epicardial side of the coronary vessel wall in anterior MI than those without positive remodeling.
authors: Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors: Ikuyoshi
authors: I
authors: Kusama
authors: Kiyoshi
authors: K
authors: Hibi
authors: Masami
authors: M
authors: Kosuge
authors: Shinnichi
authors: S
authors: Sumita
authors: Kengo
authors: K
authors: Tsukahara
authors: Jun
authors: J
authors: Okuda
authors: Toshiaki
authors: T
authors: Ebina
authors: Satoshi
authors: S
authors: Umemura
authors: Kazuo
authors: K
authors: Kimura
mesh_terms: D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D010496:Pericardium / Q000000981:diagnostic imaging / Q000378:metabolism; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D018084:Ultrasonography, Interventional