This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.03.073v1 49/1/23    most recent 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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Valgimigli, M. Articles by Serruys, P. W. Search for Related Content PubMed PubMed Citation Articles by Valgimigli, M. Articles by Serruys, P. W.

CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Plaque Composition in the Left Main Stem Mimics the Distal But Not the Proximal Tract of the Left Coronary Artery

Influence of Clinical Presentation, Length of the Left Main Trunk, Lipid Profile, and Systemic Levels of C-Reactive Protein

Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands

Manuscript received December 1, 2005; revised manuscript received February 28, 2006, accepted March 7, 2006.

^_* Reprint requests and correspondence: Prof. Patrick W. Serruys, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).

OBJECTIVES: We sought to investigate whether plaques located in the left main stem (LMS) differ in terms of necrotic core content from those sited in the proximal tract of the left coronary artery.

BACKGROUND: Plaque composition, favoring propensity to vulnerability, might be nonuniformly distributed along the vessel, which might explain the greater likelihood for plaque erosion or rupture to occur in the proximal but not in the distal tracts of the coronary artery or in LMS.

METHODS: A total of 72 patients were included prospectively; 48 (32 men; mean age 57 ± 11 years; 25 with stable angina and 23 affected by acute coronary syndromes) underwent a satisfactory nonculprit vessel investigation through spectral analysis of intravascular ultrasound radiofrequency data (IVUS-Virtual Histology, Volcano Corp., Rancho Cordova, California). The region of interest was subsequently divided into LMS and LMS carina, followed by 6 consecutive nonoverlapping 6-mm segments in left anterior descending artery in 34 patients or in circumflex artery in 14 patients.

RESULTS: Necrotic core content (%): 1) was minimal in LMS (median [interquartile range]: 4.6 [2 to 7]), peaked in the first 6-mm coronary segment (11.8 [8 to 16]; p < 0.01), and then progressively decreased distally; 2) was overall greater in patients with acute coronary syndromes (11.4 [5.5 to 19.8]) than stable angina (7.3 [3.2 to 12.9]; p < 0.001); 3) was largely independent from plaque size; and 4) did not correlate to systemic levels of C-reactive protein or lipid profile.

CONCLUSIONS: Plaques located in the LMS carry minimal necrotic content. Thus, they mimic the distal but not the proximal tract of the left coronary artery, where plaque rupture or vessel occlusion occurs more frequently.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CFX = circumflex artery   CRP = C-reactive protein   CSA = cross-sectional area   EEM = external elastic membrane   HDL = high-density lipoprotein   IQR = interquartile range   IVUS = intravascular ultrasound   LAD = left anterior descending artery   LDL = low-density lipoprotein   LMS = left main stem   VH = virtual histology

This article has been cited by other articles:

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				G. A. Rodriguez-Granillo, S. de Winter, N. Bruining, J. M.R. Ligthart, H. M. Garcia-Garcia, M. Valgimigli, P. J. de Feyter, and on behalf of the EUROPA/PERSPECTIVE Investigators Effect of perindopril on coronary remodelling: insights from a multicentre, randomized study Eur. Heart J., October 1, 2007; 28(19): 2326 - 2331. [Abstract] [Full Text] [PDF]