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Limits: Publication Date from 2003/10/01 to
2005/02/01

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1:
Circulation. 2004 Aug 24;110(8):928-33. Epub 2004 Aug 16.

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Comparison of coronary
plaque rupture between stable angina and acute myocardial infarction: a
three-vessel intravascular ultrasound study in 235
patients.

Hong MK, Mintz GS, Lee CW, Kim YH, Lee
SW, Song JM, Han KH, Kang DH, Song JK, Kim JJ, Park SW, Park
SJ.

Department of Medicine, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, Korea.

BACKGROUND: We
evaluated the incidence and predictors of single and multiple plaque
ruptures in acute myocardial infarction (AMI) and stable angina pectoris
(SAP). METHODS AND RESULTS: We performed 3-vessel intravascular
ultrasound (IVUS) examination in 235 patients: 122 had AMI, and 113 had
SAP. Plaque rupture of infarct-related or target lesions occurred in 80
AMI patients (66%) and in 31 SAP patients (27%) (P<0.001).
Non-infarct-related or non-target artery plaque ruptures occurred in 21
AMI patients (17%) and 6 SAP patients (5%) (P=0.008). Multiple plaque
ruptures were observed in 24 AMI (20%) and 7 SAP patients (6%)
(P=0.004). Therefore, at least 1 plaque rupture in any coronary artery
was noted in 84 AMI patients (69%) and 35 SAP patients (31%)
(P<0.001). Overall, the only independent clinical predictor of plaque
rupture in the infarct-related/target lesion was AMI (P<0.01; OR,
4.867; 95% CI, 2.734 to 8.661). The only independent clinical predictor
of plaque rupture in AMI patients was an elevated C-reactive protein
(CRP) level (P=0.035; OR, 2.139; 95% CI, 1.053 to 4.343). Conversely, in
SAP patients, the only independent clinical predictor of plaque rupture
was diabetes mellitus (P=0.034; OR, 2.553; 95% CI, 1.071 to 6.085). The
only independent clinical predictor of multiple plaque ruptures was AMI
(P=0.003; OR, 3.752; 95% CI, 1.546 to 9.105). CONCLUSIONS: Three-vessel
IVUS imaging showed that culprit lesion plaque rupture, secondary remote
plaque ruptures, and multiple plaque ruptures were all more common in
AMI patients than SAP patients. In AMI patients, plaque rupture was
associated with a high CRP level, whereas in SAP patients, plaque
rupture was more common in those with diabetes.

PMID: 15313951
[PubMed - in process]

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