Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impact of Plaque Composition on Long-Term Clinical Outcomes in Patients with Coronary Artery Occlusive Disease

  • Kim, Ki Hong (Division of Cardiology, Konyang University Hospital) ;
  • Kim, Wan Ho (Cardiology, Andong Sungso Hospital) ;
  • Park, Hyun Woong (Division of Cardiology, Konyang University Hospital) ;
  • Song, In Girl (Division of Cardiology, Konyang University Hospital) ;
  • Yang, Dong Ju (Division of Cardiology, Konyang University Hospital) ;
  • Seo, Young Hoon (Division of Cardiology, Konyang University Hospital) ;
  • Yuk, Hyung Bin (Division of Cardiology, Konyang University Hospital) ;
  • Park, Yo Han (Division of Cardiology, Konyang University Hospital) ;
  • Kwon, Taek Geun (Division of Cardiology, Konyang University Hospital) ;
  • Rihal, Charanjit S. (Cardiology, Mayo Clinic) ;
  • Lerman, Amir (Cardiology, Mayo Clinic) ;
  • Lee, Moo-Sik (Division of Epidemiology, Konyang University) ;
  • Bae, Jang-Ho (Division of Cardiology, Konyang University Hospital)
  • Published : 2013.06.30
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Abstract

Background and Objectives: It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. Subjects and Methods: The study subjects consisted of 339 consecutive patients (mean $61.7{\pm}12.2$ years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. Results: Patients with high fibrofatty volume (FFV,> $8.90mm^3$, n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV ($FFV{\leq}8.90mm^3$, n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE. Conclusion: FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.

Keywords

References

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