Abstract 2459: Clinical Factors Associated with Vulnerable Plaque: An Intravascular Ultrasound Radiofrequency Data Analysis
Background: Atherosclerotic lesions with large necrotic core and an overlying thin fibrous cap (TCFA) are central in the pathogenesis of vulnerable plaque. The clinical determinants of necrotic core composition in coronary plaque are unknown.
Methods: Following informed consent, patients undergoing coronary angiography between March 2004 and May 2006 were enrolled in the Diabetes Genome Project (DGP). The main scientific objective of the DGP is to identify and characterize genetic differences among diabetic patients with atherosclerosis. A subset of these patients underwent intravascular ultrasound and are the focus of this study. Plaque elements (fibrous, fibrolipidic, dense calcium, and necrotic core) were characterized by a novel imaging platform that involves specific spectral analysis of IVUS radiofrequency signals (IVUS-Virtual Histology TM). Atherosclerotic lesions with greater than 40% plaque burden were used in the analysis. A multivariable regression model was performed with a step-wise selection process to determine variables associated with necrotic core.
Results: A total of 136 vessels from 132 patients were included in the analysis. At baseline, the average age was 64±11 years, 90% were Caucasian, 35% had diabetes mellitus, 36% had an acute coronary syndrome (ACS), and 39% were taking an angiotensin-converting enzyme inhibitor (ACE-inhibitor). The table⇓ below shows clinical factors associated with necrotic core.
Conclusions: Necrotic core, a major constituent of vulnerable plaque, clusters in Caucasians, ACS patients, and patients with elevated triglycerides. Interestingly, ACE-inhibitor use is associated with a decrease in necrotic core.