title: Age-related effects of smoking on culprit lesion plaque vulnerability as assessed by grayscale and virtual histology-intravascular ultrasound.
abstract: BACKGROUND
  Although smoking is a risk factor for coronary atherosclerosis, the age-related impact on lesion characteristics and plaque instability remains unclear.
  
  
  METHODS
  In ADAPT-DES, 780 patients with 916 culprit lesions were evaluated by preprocedural grayscale and virtual histology-intravascular ultrasound.
  
  
  RESULTS
  Current smokers (smoking within 1 month) more often presented with acute coronary syndrome (67 vs. 51 vs. 51%, P<0.05) compared with former smokers (no smoking for >1 month) or nonsmokers. In patients 65 or more years of age, current smokers (vs. nonsmokers) showed larger normalized volumes of plaque and media [8.6 (7.8-9.4) vs. 7.2 (6.8-7.7) mm/mm, P=0.016] and external elastic membrane [14.4 (13.2-15.5) vs. 12.8 (12.2-13.4) mm/mm, P=0.05]. At the minimal lumen area site, despite a greater plaque burden, the larger external elastic membrane area [14.4 (13.1-15.7) vs. 12.0 (11.3-12.7) mm, P=0.003] contributed toward preserving the minimal lumen area [2.6 (2.4-2.7) vs. 2.6 (2.5-2.7) mm, P=0.91] in current smokers (vs. nonsmokers) 65 or more years of age. Moreover, current smokers (vs. nonsmokers) 65 or more years of age showed a greater normalized necrotic core volume [1.19 (0.96-1.46) vs. 0.75 (0.66-0.85) mm/mm, P=0.0007], more thin-cap fibroatheromas (61 vs. 48%, P=0.04), and plaque ruptures (38 vs. 26%, P=0.051). Conversely, in patients younger than 65 years of age, there was no significant difference in culprit lesion morphology among current, former, and nonsmokers.
  
  
  CONCLUSIONS
  In patients 65 or more years (not in patients<65 years), smoking increased culprit lesion plaque instability (greater plaque with more necrotic core, thin-cap fibroatheromas, positive remodeling, and plaque ruptures).
authors.affiliation: aCardiovascular Research Foundation bColumbia University Medical Center/New York-Presbyterian Hospital, New York, New York cWellmont CVA Heart Institute, Kingsport, Tennessee dSanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte eReid Heart Center, FirstHealth of the Carolinas, Pinehurst fLeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina, USA gAsan Medical Center, Seoul, Korea hHelios Amper-Klinikum, Dachau, Germany iShaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.forename: Peter L
authors.initials: PL
authors.lastname: Duffy
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Takehisa
authors.initials: T
authors.lastname: Shimizu
authors.forename: Claire
authors.initials: C
authors.lastname: Litherland
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D018084:Ultrasonography, Interventional; D066253:Vascular Remodeling