This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Takarada, S. Articles by Akasaka, T. Search for Related Content PubMed Articles by Takarada, S. Articles by Akasaka, T.

The Effect of Lipid and Inflammatory Profiles on the Morphological Changes of Lipid-Rich Plaques in Patients With Non–ST-Segment Elevated Acute Coronary Syndrome

Follow-Up Study by Optical Coherence Tomography and Intravascular Ultrasound

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan

^_* Reprint requests and correspondence: Dr. Takashi Akasaka, Department of Cardiovascular Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan (Email: akasat{at}wakayama-med.ac.jp).

Objectives: The aim of this study was to determine the relationship between the morphological changes of nonculprit lipid-rich plaques and several clinical profiles in patients with non–ST-segment elevated acute coronary syndrome (NSTEACS).

Background: Identification of coronary lesion with morphological characteristics of rupture-prone plaques is still difficult.

Methods: Eighty-two consecutive patients with NSTEACS who underwent percutaneous coronary intervention were enrolled. The changes in total atheroma volume (TAV) of residual nonculprit lipid-rich plaques and the changes in the corresponding fibrous cap thickness (FCT) were assessed by intravascular ultrasound and optical coherence tomography, respectively, at baseline and after 9 months.

Results: The percentage changes in TAV (mm³) of lipid-rich plaques and in the corresponding FCT (µm) over the 9-month follow-up period were 3.1 ± 11% and 15 ± 17%, respectively. There was no significant correlation between the changes in TAV and those in FCT. The change in TAV showed a significant correlation with reduction of the low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (r = 0.42, p < 0.01). In contrast, the change in FCT showed no correlation with LDL/HDL ratio but had a significant positive correlation with changes in high-sensitivity C-reactive protein (r = 0.44, p < 0.01). Furthermore, in multivariate logistic analysis, statin use was an independent predictor of changes in well-stabilized plaques that showed both TAV reduction and FCT increase.

Conclusions: The changes in TAV and FCT of coronary plaques over a 9-month observation period were related to 2 different independent factors (i.e., reduction of LDL-cholesterol and high-sensitivity C-reactive protein, respectively). Furthermore, lipid-lowering therapy with statin has the potential to stabilize these parameters by both plaque reduction and FCT.

Key Words: coronary plaques • optical coherence tomography

Abbreviations and Acronyms   CI = confidence interval   FCT = fibrous-cap thickness   HDL = high-density lipoprotein   hs-CRP = high-sensitivity C-reactive protein   IVUS = intravascular ultrasound   LDL = low-density lipoprotein   NSTEACS = non–ST-segment elevated acute coronary syndrome   OCT = optical coherence tomography   OR = odds ratio   PCI = percutaneous coronary intervention   TAV = total atheroma volume