Jinwei Tian1, Harold Dauerman2, Catalin Toma3, Habib Samady4, Tomonori Itoh5, Shoichi Kuramitsu6, Takenori Domei6, Haibo Jia1, Rocco Vergallo7, Tsunenari Soeda7, Sining Hu1, Yoshiyasu Minami7, Hang Lee8, Bo Yu9, Ik-Kyung Jang10. 1. Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 2. University of Vermont, Fletcher Allen Healthcare, Burlington, Vermont. 3. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Emory University Hospital, Atlanta, Georgia. 5. Division of Cardiology, Memorial Heart Center, Iwate Medical School, Morioka, Japan. 6. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 7. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 8. Biostatistics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 9. Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com. 10. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: ijang@partners.org.
Abstract
BACKGROUND: The relationship between features of vulnerable plaque and angiographic coronary stenosis is unknown. OBJECTIVES: The purpose of this study was to systematically investigate the absolute number, relative prevalence, and characteristics of thin-cap fibroatheroma (TCFA) at different degrees of stenosis using optical coherence tomography (OCT), intravascular ultrasound, and coronary angiography. METHODS: We identified 643 plaques from 255 subjects who underwent OCT imaging in all 3 coronary arteries. They were divided into 3 groups on the basis of angiographic diameter stenosis: Group A (30% to 49%, n = 325), Group B (50% to 69%, n = 227), and Group C (>70%, n = 91). RESULTS: OCT showed that the absolute number of TCFA was greatest in Group A (n = 58), followed by Groups B (n = 40) and C (n = 33). However, the relative prevalence of TCFA was higher in Group C (36%) than in Groups A (18%) or B (18%) (p = 0.003 and p = 0.002, respectively). Fibrous cap of TCFA was thinner in Group C than in Groups A (p < 0.001) or B (p = 0.001). intravascular ultrasound showed that the plaque burden of TCFA was largest in Group C (80.1 ± 7.4%), compared with Groups B (67.5 ± 9.4%) and A (58.1 ± 8.4%). TCFA in Group C had a higher remodeling index than those in Group A (p = 0.002). CONCLUSIONS: The absolute number of TCFA is 3 times greater in nonsevere stenosis than in severe stenosis. It is, however, twice as likely for a lesion to be TCFA in cases of severe stenosis than in nonsevere stenosis. Moreover, TCFA in severely-stenotic areas had more features of plaque vulnerability.
BACKGROUND: The relationship between features of vulnerable plaque and angiographic coronary stenosis is unknown. OBJECTIVES: The purpose of this study was to systematically investigate the absolute number, relative prevalence, and characteristics of thin-cap fibroatheroma (TCFA) at different degrees of stenosis using optical coherence tomography (OCT), intravascular ultrasound, and coronary angiography. METHODS: We identified 643 plaques from 255 subjects who underwent OCT imaging in all 3 coronary arteries. They were divided into 3 groups on the basis of angiographic diameter stenosis: Group A (30% to 49%, n = 325), Group B (50% to 69%, n = 227), and Group C (>70%, n = 91). RESULTS: OCT showed that the absolute number of TCFA was greatest in Group A (n = 58), followed by Groups B (n = 40) and C (n = 33). However, the relative prevalence of TCFA was higher in Group C (36%) than in Groups A (18%) or B (18%) (p = 0.003 and p = 0.002, respectively). Fibrous cap of TCFA was thinner in Group C than in Groups A (p < 0.001) or B (p = 0.001). intravascular ultrasound showed that the plaque burden of TCFA was largest in Group C (80.1 ± 7.4%), compared with Groups B (67.5 ± 9.4%) and A (58.1 ± 8.4%). TCFA in Group C had a higher remodeling index than those in Group A (p = 0.002). CONCLUSIONS: The absolute number of TCFA is 3 times greater in nonsevere stenosis than in severe stenosis. It is, however, twice as likely for a lesion to be TCFA in cases of severe stenosis than in nonsevere stenosis. Moreover, TCFA in severely-stenotic areas had more features of plaque vulnerability.
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