Characteristics of plaque disruption by intravascular ultrasound in women presenting with myocardial infarction without obstructive coronary artery disease.
BACKGROUND
In a prospective study, we previously identified plaque disruption (PD: plaque rupture or ulceration) in 38% of women with myocardial infarction (MI) without angiographically obstructive coronary artery disease (CAD), using intravascular ultrasound (IVUS). Underlying plaque morphology has not been described in these patients and may provide insight into the mechanisms of MI without obstructive CAD.


METHODS
Forty-two women with MI and <50% angiographic stenosis underwent IVUS (n = 114 vessels). Analyses were performed by a blinded core laboratory. Sixteen patients had PD (14 ruptures and 5 ulcerations in 18 vessels). Plaque area, % plaque burden, lumen area stenosis, eccentricity, and remodeling index were calculated for disrupted plaques and largest plaque by area in each vessel.


RESULTS
Disrupted plaques had lower % plaque burden than the largest plaque in the same vessel (31.9% vs 49.8%, P = .005) and were rarely located at the site of largest plaque (1/19). Disrupted plaques were typically fibrous and were not more eccentric or remodeled than the largest plaque in the same vessel.


CONCLUSIONS
Plaque disruption was often identifiable on IVUS in women with MI without obstructive CAD. Plaque disruption in this patient population occurred in fibrous or fibrofatty plaques and, contrary to expectations based on prior studies of plaque vulnerability, did not typically occur in eccentric, outwardly remodeled, or soft plaque in these patients. Plaque disruption rarely occurred at the site of the largest plaque in the vessel. These findings suggest that the pathophysiology of PD in women with MI without angiographically obstructive CAD may be different from MI with obstructive disease and requires further investigation.
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Sohah N
SN
Iqbal
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Frederick
F
Feit
Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.
G B John
GB
Mancini
Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.
David
D
Wood
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Rima
R
Patel
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Ivan
I
Pena-Sing
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Michael
M
Attubato
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Leonid
L
Yatskar
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
James N
JN
Slater
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY.
Judith S
JS
Hochman
Cardiovascular Clinical Research Center, Department of Medicine, New York University School of Medicine, New York, NY. Electronic address: Harmony.Reynolds@nyumc.org.
Harmony R
HR
Reynolds
D017023:Coronary Angiography; D054059:Coronary Occlusion; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional / Q000379:methods*