Plaque Characteristics in Culprit Lesions and Inflammatory Status in Diabetic Acute Coronary Syndrome Patients
Young Joon Hong, MD, PhD,
Myung Ho Jeong, MD, PhD, FACC, FAHA, FESC, FSCAI*,
Yun Ha Choi, RN,
Jum Suk Ko, MD,
Min Goo Lee, MD,
Won Yu Kang, MD,
Shin Eun Lee, MD,
Soo Hyun Kim, MD,
Keun Ho Park, MD,
Doo Sun Sim, MD,
Nam Sik Yoon, MD,
Hyun Ju Yoon, MD,
Kye Hun Kim, MD, PhD,
Hyung Wook Park, MD, PhD,
Ju Han Kim, MD, PhD,
Youngkeun Ahn, MD, PhD, FACC, FSCAI,
Jeong Gwan Cho, MD, PhD, FACC,
Jong Chun Park, MD, PhD,
Jung Chaee Kang, MD, PhD
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Figure 1 Ruptured Plaque Cavity, Residual Fibrous Cap, and Surrounding Thrombus
An example of ruptured plaque cavity, residual fibrous cap, and surrounding thrombus in 71-year-old diabetic patient presented with non–ST-segment elevation myocardial infarction. A ruptured plaque contained a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Rupture sites separated by a length of artery containing smooth lumen contours without cavities were considered to represent different plaque ruptures (multiple plaque ruptures). Thrombus was an intraluminal mass having a layered or lobulated appearance, evidence of blood flow (microchannels) within the mass, and speckling or scintillation.
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Figure 2 Images of TCFA
Grayscale intravascular ultrasound (IVUS) (A) and virtual histology (VH)-IVUS (B) images of thin-cap fibroatheroma (TCFA). We used VH-IVUS to classify the color-coded tissue into 4 major components: green (fibrotic); yellow-green (fibro-fatty); white (dense calcium); and red (necrotic core). We defined TCFA as a necrotic core  10% of plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of 40% plaque burden. Grayscale IVUS showed the large amount of heterogeneous plaque (A), VH-IVUS showed a necrotic core-rich plaque without evidence of fibrous cap (TCFA) (B).
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Figure 3 The Incidences of Multiple Plaque Ruptures and Thrombus
The incidences of multiple plaque ruptures (A) and intravascular ultrasound (IVUS)-detected thrombus (B) in 112 patients with acute myocardial infarction with plaque ruptures. A ruptured plaque contained a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Rupture sites separated by a length of artery containing smooth lumen contours without cavities were considered to represent different plaque ruptures (multiple plaque ruptures). Thrombus was an intraluminal mass having a layered or lobulated appearance, evidence of blood flow (microchannels) within the mass, and speckling or scintillation. Multiple plaque ruptures (A) and thrombus (B) were observed more frequently in diabetic patients compared with nondiabetic patients.
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Figure 4 The Plaque Cavity Area and Ruptured Plaque Length
The plaque cavity area (A) and ruptured plaque length (B) in 112 patients with acute myocardial infarction with plaque ruptures. A ruptured plaque contained a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Plaque cavity was measured and extrapolated to the ruptured capsule area. Plaque cavity area was significantly greater in diabetic patients compared with nondiabetic patients (A). Ruptured plaque length was significantly longer in diabetic patients compared with nondiabetic patients (B).
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Figure 5 The hsCRP Levels
The high-sensitivity C-reactive protein (hs-CRP) levels according to the presence/absence of multiple plaque ruptures (A) and according to the presence/absence of intravascular ultrasound-detected thrombus (B) in 112 patients with acute myocardial infarction with plaque ruptures. We analyzed hs-CRP turbidimetrically with sheep antibodies against human CRP; this has been validated against the Dade-Behring method. We found that hs-CRP levels were significantly greater in patients with multiple plaque ruptures compared with patients without multiple plaque ruptures (A) and also were significantly greater in patients with intravascular ultrasound-detected thrombus compared with patients without intravascular ultrasound-detected thrombus (B).
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Figure 6 The Absolute and Relative Plaque Areas at the Minimum Lumen Sites
The absolute (A) and relative (B) plaque areas at the minimum lumen sites in 310 virtual histology-intravascular ultrasound (VH-IVUS) subset. We used VH-IVUS to classify the color-coded tissue into 4 major components: green (fibrotic, FT); yellow-green (fibro-fatty, FF); white (dense calcium, DC); and red (necrotic core, NC). The absolute NC and DC areas and percent NC and DC areas were significantly greater in diabetic patients compared with nondiabetic patients; conversely, percent FT area was significantly smaller in diabetic patients compared with nondiabetic patients.
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Figure 7 The Volumetric Absolute and Relative Plaque Components
The volumetric absolute (A) and relative (B) plaque components in 310 virtual histology-intravascular ultrasound (VH-IVUS) subset. We used VH-IVUS to classify the color-coded tissue into 4 major components: green (fibrotic, FT); yellow-green (fibro-fatty, FF); white (dense calcium, DC); and red (necrotic core, NC). The absolute NC and DC volumes and percent NC and DC volumes were significantly greater in diabetic patients compared with nondiabetic patients; conversely, percent FT and FF volumes were significantly smaller in diabetic patients compared with nondiabetic patients.
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Figure 8 The Incidence of Culprit Lesion TCFA
The incidence of culprit lesion TCFA in 310 VH-IVUS subset. We used VH-IVUS to classify the color-coded tissue into 4 major components: green (fibrotic); yellow-green (fibro-fatty); white (dense calcium); and red (necrotic core). We defined TCFA as a necrotic core 10% of plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of 40% plaque burden. The presence of at least one TCFA and multiple TCFAs within culprit lesions were observed more frequently in diabetic patients (brown bars) compared with nondiabetic patients (orange bars). Abbreviations as in Figure 2.
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