Author + information
- Received April 8, 2009
- Revision received June 16, 2009
- Accepted July 14, 2009
- Published online April 13, 2010.
- Takashi Kubo, MD, PhD⁎,
- Akiko Maehara, MD⁎,⁎ (, )
- Gary S. Mintz, MD⁎,
- Hiroshi Doi, MD, PhD⁎,
- Kenichi Tsujita, MD, PhD⁎,
- So-Yeon Choi, MD, PhD⁎,
- Osamu Katoh, MD†,
- Kenya Nasu, MD†,
- Andreas Koenig, MD‡,
- Michael Pieper, MD§,
- Jason H. Rogers, MD∥,
- William Wijns, MD¶,
- Dirk Böse, MD#,
- M. Pauliina Margolis, MD, PhD⁎⁎,
- Jeffrey W. Moses, MD⁎,
- Gregg W. Stone, MD⁎ and
- Martin B. Leon, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, New York, New York 10022
Objectives We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology.
Background Plaque stability is related to its histological composition.
Methods We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden ≥40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS–derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque.
Results At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs “healed,” 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm2[8.2 to 10.7 mm2] vs. 6.9 mm2[6.0 to 8.2 mm2], p = 0.021), vessel (18.7 mm2[17.3 to 28.6 mm2] vs. 15.5 mm2[13.3 to 16.6 mm2]; p = 0.010), and plaque (9.7 mm2[9.6 to 15.7 mm2] vs. 8.4 mm2[7 to 9.7 mm2], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm2[6.2 to 10.0 mm2] to 9.0 mm2[6.5 to 12.0 mm2], p < 0.001), VH-TCFAs (8.6 mm2[7.3 to 9.9 mm2] to 9.5 mm2[7.8 to 10.8 mm2], p = 0.024), and ThCFAs (8.6 mm2[6.8 to 10.2 mm2] to 8.8 mm2[7.1 to 11.4 mm2], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque.
Conclusions Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.
Volcano Corporation (Rancho Cordova, California)has sponsored this registry. Dr. Kubo has received research grant support from Volcano Corporation. Dr. Mintz is a member of the Speakers' Bureau, serves as a consultant, has received research/grant support, and is a stockholder with Volcano Corporation. Dr. Rogers is a consultant for Volcano Corporation. Dr. Margolis is an employee and stockholder with Volcano Corporation. Drs. Stone and Leon serve as consultants for Volcano Corporation.
- Received April 8, 2009.
- Revision received June 16, 2009.
- Accepted July 14, 2009.
- American College of Cardiology Foundation