title: The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction.
abstract: OBJECTIVE
  Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability.
  
  
  METHODS
  Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions.
  
  
  RESULTS
  The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions.
  
  
  CONCLUSIONS
  Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion.
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.|Department of Cardiology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China.
authors.forename: Guian
authors.initials: G
authors.lastname: Zheng
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.|Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Sudo
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Haruta
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukamachi
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Kimie
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Higuchi
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.|Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hiro
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan.|Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional