title: Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy).
abstract: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter registry of 8,582 consecutive stable and unstable patients who underwent percutaneous coronary intervention using a drug-eluting stent. We sought to identify key morphologic features leading to ST-segment elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI) or unstable angina pectoris (UA) versus stable coronary artery disease (CAD) presentation. In the prespecified grayscale and virtual histology (VH) substudy of ADAPT-DES, preintervention imaging identified 676 patients with a single culprit lesion. The relation between lesion morphology and clinical presentation was compared among patients with (1) STEMI, (2) NSTEMI or UA, and (3) stable CAD. Intravascular ultrasound identified more plaque rupture and VH thin-cap fibroatheroma (TCFA) in STEMI lesions compared with NSTEMI/UA or stable CAD lesions; conversely, fibroatheromas appeared more often calcified with a thick fibrous cap in stable CAD. Minimum lumen cross-sectional area (MLA) was smaller with larger plaque burden and positive remodeling in STEMI lesions. Lesions with plaque rupture versus those without plaque rupture showed higher prevalence of VH-TCFA and larger plaque burden with positive remodeling, especially in patients with STEMI. Multivariate analysis showed that in the lesions with plaque rupture, plaque burden at the MLA site was the only independent predictor for STEMI (cutoff of plaque burden = 85%) and in lesions without plaque rupture, MLA was the only independent predictor for STEMI (cutoff of MLA = 2.3 mm(2)). In conclusion, culprit lesions causing STEMI have smaller lumen areas, greater plaque burden, and more plaque rupture or VH-TCFA compared with NSTEMI/UA or stable CAD; in lesions with plaque rupture, only plaque burden predicted STEMI, and in lesions without plaque rupture, only MLA area predicted STEMI.
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
authors: Liang
authors: L
authors: Dong
authors: Cardiovascular Research Foundation, New York, New York.
authors: Gary S
authors: GS
authors: Mintz
authors: Helios Amper-Klinikum, Dachau, Germany.
authors: Bernhard
authors: B
authors: Witzenbichler
authors: Wellmont CVA Heart Institute, Kingsport, Tennessee.
authors: D Christopher
authors: DC
authors: Metzger
authors: Sanger Heart and Vascular Institute, Charlotte, North Carolina.
authors: Michael J
authors: MJ
authors: Rinaldi
authors: FirstHealth Moore Regional Hospital, Pinehurst, North Carolina.
authors: Peter L
authors: PL
authors: Duffy
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Shaare Zedek Medical Center, Jerusalem, Israel.
authors: Giora
authors: G
authors: Weisz
authors: LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina.
authors: Thomas D
authors: TD
authors: Stuckey
authors: LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina.
authors: Bruce R
authors: BR
authors: Brodie
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Wonkwang University Hospital, Iksan, South Korea.
authors: Kyeong Ho
authors: KH
authors: Yun
authors: Cardiovascular Research Foundation, New York, New York.
authors: Ke
authors: K
authors: Xu
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors: Ajay J
authors: AJ
authors: Kirtane
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors: Gregg W
authors: GW
authors: Stone
authors: Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: amaehara@crf.org.
authors: Akiko
authors: A
authors: Maehara
mesh_terms: D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional / Q000379:methods*