Abstract 1982: In Vivo Virtual Histology Intravascular Ultrasound Correlates of Risk Factors for Sudden Coronary Death in Men: Results from the Prospective, Global, Multi-center VH-IVUS Registry
Background: Histopathological data shows that cigarette smoking and a total-cholesterol-to-high-density-lipoprotein ratio (TC/HDL) >5 are associated to sudden coronary death (SCD) in men. We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these risk factors.
Methods and Results: We performed whole pullback VH-IVUS analyses in a consecutive series of 473 male pts and measured the four basic VH-IVUS coronary plaque components - fibrous (FI), fibro-fatty (FF), dense calcium (DC) and necrotic core (NC) - as well as calculated a NC/DC ratio. Pts age was 61±11years, with 27% current smokers and 69% with a lipid disorder. Among VH-IVUS parameters, the NC/DC ratio was the only parameter related both to the TC/HDL ratio (r=0.18, p=0.0008) and LDL-C levels (r=0.17, p=0.002); it had a negative correlation with HDL-C levels (r=0.11, p=0.03), and was significantly higher for smokers [median: 1.98 (1.35, 3.18)] vs. non-smokers [median: 1.70 (1.23, 2.53), p=0.006]. A NC/DC value >3 was the threshold that best identified smokers with a TC/HDL>5 (odds ratio 3.0, p=0.0001). ROC curves showed superiority of the NC/DC ratio (A2: 0.64, p<0.0001) over %DC (A2: 0.58, p=0.006) or %NC (A2: 0.51, p=0.43) as isolate parameters to identify pts with a risk profile for SCD (Figure⇓).
Conclusions: In diseased coronary segments the ratio of necrotic core to calcification detected by VH-IVUS is related to previously-published pathologic risk factors for SCD.