Implication of Plaque Color Classification for Assessing Plaque VulnerabilityA Coronary Angioscopy and Optical Coherence Tomography Investigation
Takashi Kubo, MD, PhD,
Toshio Imanishi, MD, PhD,
Shigeho Takarada, MD, PhD,
Akio Kuroi, MD,
Satoshi Ueno, MD,
Takashi Yamano, MD,
Takashi Tanimoto, MD,
Yoshiki Matsuo, MD, PhD,
Takashi Masho, MD,
Hironori Kitabata, MD,
Atsushi Tanaka, MD, PhD,
Nobuo Nakamura, MD,
Masato Mizukoshi, MD, PhD,
Yoshiaki Tomobuchi, MD, PhD,
Takashi Akasaka, MD, PhD*
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
* Reprint requests and correspondence: Dr. Takashi Akasaka, Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan. (Email: akasat{at}wakayama-med.ac.jp).
Objectives: The purpose of this study was to assess the relationship between plaque color evaluated by coronary angioscopy and fibrous cap thickness estimated by optical coherence tomography (OCT) in vivo.
Background: Yellow color intensity of coronary plaque evaluated by coronary angioscopy might be associated with plaque vulnerability.
Methods: Seventy-seven coronary artery plaques in patients with acute coronary syndrome were observed by angioscopy and OCT. Plaque color was graded as white, light yellow, yellow, or intensive yellow.
Results: There were significant differences among the groups classified by plaque color with respect to the fibrous cap thickness estimated by OCT: 389 ± 74 µm in white plaques, 228 ± 51 µm in light yellow plaques, 115 ± 28 µm in yellow plaques, and 59 ± 14 µm in intensive yellow plaques (p < 0.0001). In Spearman rank-order correlation analysis, there was a significant negative correlation between yellow color intensity and fibrous cap thickness (p < 0.0001). Furthermore, 80% of intensive yellow plaques were thin cap fibroatheroma with a cap thickness of  65 µm.
Conclusions: The plaque color in coronary angioscopy was determined by the fibrous cap thickness, which was assessed by OCT. Although coronary angioscopy remains a specialized research tool, it might allow us to evaluate plaque vulnerability.
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | AMI = acute myocardial infarction | | IVUS = intravascular ultrasound | | OCT = optical coherence tomography | | SD = standard deviation | | TCFA = thin cap fibroatheroma | | TIMI = Thrombolysis In Myocardial Infarction |
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