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CLINICAL RESEARCH: INTRAVASCULAR IMAGING AND VULNERABLE PLAQUE

Incidence and Clinical Correlates of Ruptured Plaques in Saphenous Vein Grafts

An Intravascular Ultrasound Study

Jerzy Pregowski, MD^_*, Pawel Tyczynski, MD^_*, Gary S. Mintz, MD, Sang-Wook Kim, MD^_*, Adam Witkowski, MD, Ron Waksman, MD^_*, Augusto Pichard, MD^_*, Lowell Satler, MD^_*, Kenneth Kent, MD, PhD^_*, Mariusz Kruk, MD^_*, Szymon Bieganski, MD^_*, Patrick Ohlmann, MD^_* and Neil J. Weissman, MD^_*,_*

^_* Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC
Cardiovascular Research Foundation, New York, New York
Institute of Cardiology, Warsaw, Poland.

Manuscript received January 17, 2005; revised manuscript received February 13, 2005, accepted February 22, 2005.

^_* Reprint requests and correspondence: Dr. Neil J. Weissman, Washington Hospital Center, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010 (Email: neil.j.weissman{at}medstar.net).

OBJECTIVES: The goal of this study was to assess the incidence, clinical correlates, and angiographic appearance of ruptured atherosclerotic plaques detected in saphenous vein grafts (SVGs).

BACKGROUND: Ruptured atherosclerotic plaques in native coronary arteries but not in SVGs have been well described with intravascular ultrasound (IVUS).

METHODS: We reviewed 791 pre-intervention IVUS SVG studies and identified 95 ruptured plaques in 76 SVGs in 73 patients. Standard clinical, angiographic, and IVUS measurements were collected and/or measured. Ruptured plaques were compared with nonruptured plaques in 276 randomly selected patients.

RESULTS: The IVUS-detected ruptured plaques had angiographically complex morphology (95%) with ulceration (79%), intimal flap (71%), and sometimes aneurysm formation (14%). Compared with control SVG lesions, ruptured plaques occurred more often in patients with acute coronary syndromes, in older SVGs (12.3 ± 5.0 years vs. 8.6 ± 5.2 years, p < 0.001), and in patients with hypercholesterolemia (92% vs. 81%, p = 0.021) and hypertension (78% vs. 63%, p = 0.015). Multiple ruptured plaques were identified in 22 patients in 19 grafts, more often in diabetic patients (55% vs. 29%, p = 0.054). A tear in the fibrous cap could be identified in 59% of plaques; in 70% it occurred at the shoulder of the plaque and in 30% at the center of the plaque. The IVUS features of ruptured plaques included positive remodeling in 71%, which was more common than in control plaques (40%, p < 0.001).

CONCLUSIONS: Ruptured atherosclerotic plaques occur in old SVGs with an incidence of 9.7%. These lesions have a complex angiographic appearance and positive remodeling characteristics. This is similar to ruptured plaques in native arteries.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   IVUS = intravascular ultrasound   MI = myocardial infarction   SVG = saphenous vein graft   TIMI = Thrombolysis In Myocardial Infarction

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