title: Presentations of acute coronary syndrome related to coronary lesion morphologies as assessed by intravascular ultrasound and optical coherence tomography.
abstract: BACKGROUND
  Pathologically, the lesions responsible for acute coronary syndrome (ACS) are ruptures of vulnerable plaques (and occasionally fibrous-cap erosions or calcified nodules) with a superimposed thrombosis. We aimed to clarify the clinical presentations related to the morphologies of coronary lesions of ACS using intravascular ultrasound (IVUS) and optical coherence tomography (OCT).
  
  
  RESULTS
  Seventy-five culprit lesions of ACS patients were clearly assessed with IVUS and OCT. Patients were classified into two groups based on the presence or absence of a rupture of a culprit plaque as identified by OCT. Clinical characteristics and lesion morphologies were compared between the two groups. Waist circumference was significantly greater (p<0.02) and prevalence of the metabolic syndrome (MS) higher (p=0.0011) in the rupture group. The prevalence of prodromal angina was higher in patients without plaque ruptures (p<0.0001). Using multivariate analysis, the MS and prodromal angina were independent predictors of rupture of a culprit coronary plaque (odds ratio (OR): 27.30, p<0.003 and OR: 0.04, p=0.0004, respectively). Among the components of the MS, the prevalence of abdominal obesity was a significant independent predictor of rupture of a culprit plaque (OR: 4.24, p<0.02).
  
  
  CONCLUSIONS
  There are two presentations related to the coronary lesion morphologies of ACS: we should understand these aspects of ACS.
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan. ms-katou@asa-hosp.city.hiroshima.jp
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.forename: Keigo
authors.initials: K
authors.lastname: Dote
authors.forename: Shota
authors.initials: S
authors.lastname: Sasaki
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kagawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Akifumi
authors.initials: A
authors.lastname: Higashi
authors.forename: Kiho
authors.initials: K
authors.lastname: Itakura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ochiumi
authors.forename: Yu
authors.initials: Y
authors.lastname: Takiguchi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D041623:Tomography, Optical Coherence / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*