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(Circulation. 2004;110:2875-2880.)
© 2004 American Heart Association, Inc.

Imaging

Evolution of Spontaneous Atherosclerotic Plaque Rupture With Medical Therapy

Long-Term Follow-Up With Intravascular Ultrasound

Gilles Rioufol, MD, PhD; Martine Gilard, MD; Gérard Finet, MD, PhD; Isabelle Ginon, MD; Jacques Boschat, MD; Xavier André-Fouët, MD

From the Department of Hemodynamics and Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University, Lyon (G.R., G.F., I.G., X.A.-F.), and Department of Cardiology, "La Cavale Blanche" University Hospital, Brest (M.G., J.B.), France.

Correspondence to Gilles Rioufol, MD, PhD, Department of Hemodynamics, Cardiovascular Hospital, B.P. Lyon-Monchat, 69394 Lyon Cedex 03, France. E-mail gilles.rioufol{at}univ-lyon1.fr

Received March 30, 2004; de novo received May 28, 2004; accepted July 13, 2004.

Background— Ruptured coronary atheromatous plaque is generally considered to involve a high risk of subsequent clinical events. Few data are available on the natural evolution of non–culprit-lesion ruptured plaque. We therefore used serial intravascular ultrasound (IVUS) to study how such lesions, detected in the context of a first acute coronary syndrome with elevated troponin I levels, develop.

Methods and Results— Fourteen patients with 28 distinct plaque ruptures (2±1 per patient) without significant associated stenosis (minimal lumen cross-sectional area >4 mm²) were included and systematically treated with 40 mg statin and antiplatelet agent (clopidogrel and aspirin for 9 months). Mean clinical and IVUS follow-up was 22±13 months (median, 22 months). No clinical event related to the lesion under study occurred. On final IVUS examination, half (14 of 28) of the ruptured plaques had healed, and the degree of stenosis tended to diminish (stenosis, 22±17% versus 29±17% at baseline; P=0.056). No healing-prediction criterion could be identified.

Conclusions— Nearly 2 years of follow-up found that spontaneous coronary atheromatous plaque rupture without significant stenosis detected on first acute coronary syndrome healed without significant plaque modification in 50% of cases with medical therapy.

Key Words: atherosclerosis • cardiovascular diseases • catheterization • imaging • ultrasonics

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