Author + information
- Wenbin Zhang1,
- Gary Mintz2,
- Yang Cao3,
- Mitsuaki Matsumura4,
- Cheolmin Lee5,
- Tsunekazu Kakuta6 and
- Akiko Maehara7
- 1SIR RUN RUN SHAW Hospital, Elmhurst, New York, United States
- 2Cardiovascular Research Foundation, Washington, District of Columbia, United States
- 31st Aff. Hosp. Of Harbin Univ, Harbin, China
- 4Cardiovascular Research Foundation, New York, New York, United States
- 5Cardiovascular Research Foundation, New York, United States
- 6Unknown, Tsuchiura, Japan
- 7Cardiovascular Research Foundation, New York, New York, United States
We sought to investigate clinical determinants of overall disease burden and plaque vulnerability using both optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in a large cohort of patients with coronary artery disease (CAD).
We retrospectively analyzed a total of 811 patients with CAD (39.2% acute coronary syndrome [ACS]) who underwent coronary intervention. IVUS plaque burden (plaque/vessel × 100) was assessed at the minimum lumen area site; lipid, macrophages, calcium index (mean angle × length), and fibrous cap thickness by OCT were measured for the entire lesion.
The median age was 66 years with 82.1% male, 34.2% diabetic, and 53.4% with no pre-admission statins. Median lesion length was 22.7 mm, and 30.5% had a thin-cap fibroatheroma. Multivariable linear regression model (Table, all dependent variables p<0.05) showed (1) diabetes was related to lipid, calcium, and plaque burden; (2) ACS presentation was related to plaque vulnerability (more lipid and macrophages with thinner fibrous cap); (3) statin use was related to plaque stabilization (less lipid with thicker fibrous cap); (4) age was related to more calcium and less macrophages; and (5) smoking was related to more lipid and less calcium. Sex and renal function were not independent predictors of IVUS or OCT morphology.
|Fibrous Cap Thickness (μm)||Lipid Volume Index (degree × mm)||Macrophage Volume Index (degree × mm)||Calcium Volume Index (degree × mm)||Plaque Burden at Minimum Lumen Area Site (%)|
|Median (1Q, 3Q)||90 (63, 132)||1348 (730, 2217)||356 (162, 604)||193 (0, 674)||85.3 (79.9, 88.9)|
|Independent variable||Unadjusted regression coefficient (95% CI)|
|Age (per 10 years)||—||—||-52 (-75, -28)||104 (39, 170)||—|
|Diabetes||—||300 (127, 473)||—||179 (39, 319)||1.8 (0.8, 2.8)|
|ACS presentation||-28 (-37, -19)||470 (286, 653)||62 (11, 113)||—||3.6 (2.6, 4.6)|
|Smoking||—||182 (12, 351)||—||-211 (-353, -68)||—|
|Statin use pre-admission||10 (1, 19)||-194 (-374, -15)||—||—||—|
Clinical risk factors and presentation as well as pharmacologic therapy were consistent predictors of stable and unstable plaque morphology as assessed by IVUS and OCT.