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CLINICAL RESEARCH: VULNERABLE PLAQUE

The Site of Plaque Rupture in Native Coronary Arteries

A Three-Vessel Intravascular Ultrasound Analysis

Myeong-Ki Hong, MD^_*, Gary S. Mintz, MD, FACC, Cheol Whan Lee, MD^_*, Bong-Ki Lee, MD^_*, Tae-Hyun Yang, MD^_*, Young-Hak Kim, MD^_*, Jong-Min Song, MD^_*, Ki-Hoon Han, MD^_*, Duk-Hyun Kang, MD^_*, Sang-Sig Cheong, MD, Jae-Kwan Song, MD, FACC^_*, Jae-Joong Kim, MD^_*, Seong-Wook Park, MD, FACC^_* and Seung-Jung Park, MD, FACC^_*,_*

^_* Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, GangNeung, Korea
Cardiovascular Research Foundation, New York, New York.

Manuscript received October 25, 2004; revised manuscript received March 22, 2005, accepted March 29, 2005.

^_* Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea. (Email: sjpark{at}amc.seoul.kr).

OBJECTIVES: We evaluated the axial location of plaque ruptures in native coronary arteries.

BACKGROUND: It is clinically important to understand the potential sites of plaque rupture.

METHODS: We performed three-vessel intravascular ultrasound (IVUS) examination in 392 patients; 231 had acute coronary syndrome (ACS) and 161 had stable angina pectoris (SAP). The IVUS detected plaque ruptures in 206 patients: 158 ACS patients and 48 SAP patients. The distance between each coronary plaque rupture segment and the respective coronary ostium was measured with motorized IVUS transducer pullback in all three coronary arteries.

RESULTS: There were a total of 273 plaque ruptures in these 206 patients; 143 in the left anterior descending artery (LAD), 40 in the left circumflex artery (LCX), and 90 in the right coronary artery (RCA). There were 67 plaque ruptures in SAP patients and 206 in ACS patients; there were 197 culprit/target lesion plaque ruptures and 76 non-culprit/non-target lesion plaque ruptures. The LAD plaque ruptures were predominantly located between 10 and 40 mm from the LAD ostium (83%, 119 of 143). The LCX plaque ruptures were evenly distributed in the entire LCX tree. Most RCA plaque ruptures were located in segments between 10 and 40 mm (48%, 43 of 90) and in segments >70 mm from the ostium (32%, 29 of 90).

CONCLUSIONS: Three-vessel IVUS imaging showed that plaque ruptures occurred mainly in proximal segments of the LAD (83% of LAD plaque rupture), the proximal and distal segments of the RCA (48% and 32% of RCA plaque ruptures, respectively), and the entire LCX.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   LAD = left anterior descending artery   LCX = left circumflex artery   MI = myocardial infarction   RCA = right coronary artery   SAP = stable angina pectoris

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