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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

Assessment of Vulnerable Plaques Causing Acute Coronary Syndrome Using Integrated Backscatter Intravascular Ultrasound

Keiji Sano, MD, PhD^_*, Masanori Kawasaki, MD, PhD^_*,_*, Yoshiyuki Ishihara, MD^_*, Munenori Okubo, MD^_*, Kunihiko Tsuchiya, MD, PhD^_*, Kazuhiko Nishigaki, MD, PhD^_*, Xiangrong Zhou, PhD, Shinya Minatoguchi, MD, PhD^_*, Hiroshi Fujita, PhD and Hisayoshi Fujiwara, MD, PhD^_*

^_* Division of Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan
Department of Intelligent Image Information, Gifu University Graduate School of Medicine, Gifu, Japan

Manuscript received June 6, 2005; revised manuscript received September 16, 2005, accepted September 19, 2005.

^_* Reprint requests and correspondence: Dr. Hisayoshi Fujiwara, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan, 1-1 Yanagido, Gifu 501-1194, Japan. (Email: gifuim-gif{at}umin.ac.jp).

OBJECTIVES: This study aims to define tissue characteristics of vulnerable plaques before acute coronary syndrome (ACS) by use of integrated backscatter intravascular ultrasound (IB-IVUS).

BACKGROUND: Tissue characterization of coronary plaques is possible with the use of IB-IVUS.

METHODS: The subjects were 140 patients with angina pectoris, and we selected 160 coronary lesions without significant stenosis for evaluation. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter.

RESULTS: At the follow-up (30 ± 7 months), 12 plaques caused ACS after the initial IVUS examination. Ten of the 12 plaques had IVUS parameters recorded at baseline. These 10 plaques were classified as vulnerable plaques (VP), and the other plaques were classified as stable plaques (SP; n = 143). There was no significant difference of vessel area, lumen area, and plaque area between VP and SP. However, plaque burden (60 ± 9% vs. 52 ± 9%; p = 0.014), eccentricity (0.70 ± 0.10 vs. 0.55 ± 0.17; p = 0.013), remodeling index (1.30 ± 0.08 vs. 1.16 ± 0.16; p = 0.006) and percentage lipid area (72 ± 10% vs. 50 ± 16%; p < 0.0001) were greater in VP than in SP. Percentage fibrous area (23 ± 6% vs. 47 ± 14%; p < 0.0001) was smaller in VP than in SP. The sensitivities, specificities, and positive predictive values of percentage fibrous area (90%, 96%, and 69%, respectively) and percentage lipid area (80%, 90%, and 42%, respectively) for classifying VP were evaluated.

CONCLUSIONS: Tissue characteristics of VP before ACS were different from those of SP. This suggests that VP and SP as classified by IB-IVUS are useful in predicting ACS.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CSA = cross-sectional area   EEM = external elastic membrane   IB = integrated backscatter   IVUS = intravascular ultrasound   LCSA = lumen cross-sectional area   PCI = percutaneous coronary intervention   ROI = region of interest   SP = stable plaques   VP = vulnerable plaques

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