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Synergistic Effect of Cardiovascular Risk Factors on Necrotic Core in Coronary Arteries

A Report From the Global Intravascular Radiofrequency Data Analysis Registry

Héctor M. García-García, MD, MSc^_*, Patrick W. Serruys, MD, PhD^_*,_*, Gary S. Mintz, MD, Satoshi Saito, MD, Volker Klaus, MD, Pauliina Margolis, MD, PhD^||, Stephane Carlier, MD, PhD, Dick Goedhart, PhD^¶, Robert Schwartz, MD^#

^_* Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Cardiovascular Research Foundation, New York, New York
Nihon University, Tokyo, Japan
Innenstadt, Munich, Germany
^|| Volcano Corporation, Rancho Cordova, California
^¶ Cardialysis, BV, Rotterdam, the Netherlands
^# Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota

^_* Reprint requests and correspondence: Dr. Patrick W. Serruys, Thoraxcenter, Erasmus Medical Center, Department of Interventional Cardiology, Ba583, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands (Email: p.w.j.c.serruys{at}erasmusmc.nl).

Objectives: This study explored whether an individual or a cluster of risk factors affects the extent of necrotic core (NC) assessed by intravascular ultrasound (IVUS) radiofrequency data (RFD) analysis.

Background: Several systemic diseases contribute to the development of coronary artery disease.

Methods: The Global Intravascular Radiofrequency Data Analysis Registry was a prospective, multicenter, nonrandomized database that enrolled 990 patients with coronary artery disease in whom 1 major coronary artery was imaged by IVUS-RFD. For the multivariable analysis, the population was divided into 4 classes: young women, young men (both 62 years), old women, and old men (>62 years). Mean NC area was categorized as 1: top quartile (0.62 mm²) or as 0: lower 3 quartiles.

Results: Young patients had less NC compared with older patients (0.40 ± 0.36 mm² of NC vs. 0.50 ± 0.46 mm² in old patients, p = 0.0007). Nondiabetic patients had less NC than diabetic patients (0.43 ± 0.41 mm² of NC vs. 0.51 ± 0.44 mm² in diabetic patients, p = 0.02). The NC area was lower in normotensive patients (0.40 ± 0.36 mm²) than in hypertensive patients (0.48 ± 0.44 mm²) (p = 0.02). In the bivariate analysis, age, hypertension, diabetes, and prior coronary artery bypass graft were statistically significant, however in logistic regression analysis, only age (odds ratio [OR]: 1.023, 95% confidence interval [CI]: 1.009 to 1.037, p = 0.001) and diabetes (OR: 1.636, 95% CI: 1.174 to 2.279, p = 0.004) remained statistically significant. In a per-class logistic regression analyses including only diabetes as covariate, the OR in young women was 2.1 (95% CI: 0.77 to 6.0, p = 0.14), in young men the OR was 1.6 (95% CI: 0.90 to 2.7, p = 0.11), in old women the OR was 2.3 (95% CI: 1.09 to 4.9, p = 0.03), and in old men the OR was 1.6 (95% CI: 0.96 to 2.7, p = 0.07). Further, when only patients with diabetes and hypertension were included, young men (OR: 2.0, p = 0.041), old women (OR: 3.04, p = 0.046), and old men (OR: 2.2, p = 0.025) were significant.

Conclusions: Individually and collectively, age and diabetes mellitus are associated with an increase in NC by IVUS-RFD analysis.

Key Words: cardiovascular risk factors • clinical presentation • intravascular ultrasound • plaque composition

Abbreviations and Acronyms   ACS = acute coronary syndrome   CI = confidence interval   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   NC = necrotic core   OR = odds ratio   RFD = radiofrequency data