Relation Between High-Sensitivity C-Reactive Protein and Coronary Plaque Components in Patients With Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

Background and Objectives: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relationship be-tween high-sensitivity C-reactive protein (hs-CRP) levels and plaque components in 279 acute coronary syndrome (ACS) pa-tients. Subjects and Methods: We divided patients into three groups according to their hs-CRP levels {lowest tertile <0.07 mg/dL (n=93), middle tertile $\geq$0.07, <0.4 mg/dL (n=93), and highest tertile $\geq$0.4 mg/dL (n=93)}. Thin-cap fibroatheroma (TCFA) was defined as focal, necrotic core (NC)-rich ($\geq$10% of the cross-sectional area) plaques in contact with the lumen in a plaque burden $\geq$40%. Results: The highest tertile group was mostly diabetics (20%, 27%, 40%, p=0.009), and had the greatest plaque plus media volume (163$\pm$139/$mm^{3}$ vs. 201$\pm$155/$mm^{3}$ vs. 232$\pm$176/$mm^{3}$, p=0.013). The highest tertile group had the greatest absolute and % NC volumes (13.6$\pm$15.1 $mm^{3}$ vs. 14.8$\pm$14.2 $mm^{3}$ vs. 23.7$\pm$24.3 $mm^{3}$, p<0.001, and 14.9$\pm$8.7% vs. 16.0$\pm$8.7% vs. 19.5$\pm$10.2%, p=0.024, respectively). The culprit lesion TCFA was observed most frequently in the highest ter-tile group (28% vs. 35% vs. 55%, p=0.006). By multivariable analysis, absolute NC volume was an independent predictor of hs-CRP elevation {odds ratio (OR); 1.03, 95% confidence interval (CI)=1.06-1.21, p=0.004}, and hs-CRP was an independent pre-dictor of TCFA (OR; 1.86, 95% CI=1.11-2.90, p=0.010). Conclusion: VH-IVUS analysis has demonstrated that ACS patients with elevated hs-CRP have more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFA), compared with ACS patients with normal hs-CRP.