Circulation. 2004;110:3424-3429
Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148131.41425.E9
Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148131.41425.E9
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(Circulation. 2004;110:3424-3429.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
Spotty Calcification Typifies the Culprit Plaque in Patients With Acute Myocardial Infarction
An Intravascular Ultrasound Study
From the Departments of Internal Medicine and Cardiology (S.E., Y.K., M.Y., K.S., Y.S., D.F., Y.N., H. Yamashita, H. Yamagishi, K.T., J.Y.) and Pathology (M.U.), Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Cardiology (T.N., K.H.), Osaka City General Hospital, Osaka, Japan; and Department of Cardiovascular Pathology (A.E.B.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Correspondence to Junichi Yoshikawa, MD, Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan. E-mail jyoshikawa{at}med.osaka-cu.ac.jp
Received June 15, 2004; revision received August 10, 2004; accepted August 19, 2004.
Background— Calcification is a common finding in human coronary arteries; however, the relationship between calcification patterns, plaque morphology, and patterns of remodeling of culprit lesions in a comparison of patients with acute coronary syndromes (ACS) and those with stable conditions has not been documented.
Methods and Results— Preinterventional intravascular ultrasound (IVUS) images of 178 patients were studied, 61 with acute myocardial infarction (AMI), 70 with unstable angina pectoris (UAP), and 47 with stable angina pectoris (SAP). The frequency of calcium deposits within an arc of less than 90° for all calcium deposits was significantly different in culprit lesions of patients with AMI, UAP, and SAP (P<0.0001). Moreover, the average number of calcium deposits within an arc of <90° per patient was significantly higher in AMI than in SAP (P<0.0005; mean±SD, AMI 1.4±1.3, SAP 0.5±0.8). Conversely, calcium deposits were significantly longer in SAP patients (P<0.0001; mean±SD, AMI 2.2±1.6, UAP 1.9±1.8, and SAP 4.3±3.2 mm). In AMI patients, the typical pattern was spotty calcification, associated with a fibrofatty plaque and positive remodeling. In ACS patients showing negative remodeling, no calcification was the most frequent observation. Conversely, SAP patients had the highest frequency of extensive calcification.
Conclusions— Our observations show that IVUS allows the identification of vulnerable plaques in coronary arteries, not only by identifying a fibrofatty plaque and positive remodeling, but also by identifying a spotty pattern of calcification.
Key Words: coronary disease • remodeling • ultrasonics • calcium • myocardial infarction
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