Abstract 337: Predictors of Necrotic Core Volume: An In Vivo Virtual Histology Intravascular Ultrasound (VH-IVUS) Analysis of 880 Patients from the Global VH Registry
The pathophysiologic substrate of a thin-capped fibroatheroma - the most common type of vulnerable plaque - is a large necrotic core with a thin fibrous cap. Virtual histology (VH) uses radiofrequency intravascular ultrasound (IVUS) to classify plaque composition as calcified, fibrotic, fibrofatty, and necrotic core. The global VH registry (at 42 centers) is collecting volumetric multivessel VH data from patients undergoing diagnostic or interventional coronary procedures. centers. Clinical parameters, biomarkers, and conventional IVUS morphometric and volumetric VH plaque composition analysis of the entire pullback length has been performed on 880 pts. We assessed the predictors of average necrotic core cross-sectional area within a measured mean whole vessel plaque volume of 470mm3.
Results: The following variables were tested in a stepwise regression model: acute coronary syndrome (ACS), diabetes mellitus (DM), hypertension, prior myocardial infarction, familial CAD, low HDL, high LDL, high CRP, and current smoking. The resulting model was confirmed with forward, backward, and mixed model-building. The variables that remained in the model were ACS (p=0.037), DM (p=0.018), and low HDL (p=0.04). The additive effects of these three variables is shown in the figure⇓.
Conclusions: Of the many standard cardiac risk factors and presentations, only ACS, diabetes, and a low HDL predicted the amount of NC contained in a typically atherosclerotic coronary artery; and the effect of these three risk factors is additive.