Abstract 5470: Coronary Plaque Inflammation as a Predictor for Death at Long Term Follow Up
Objective: To evaluate the association between plaque inflammation and the number and clinical presentation of future coronary sybdromes after directional coronary atherectomy (DCA).
Methods: A total of 124 patients with stable or unstable angina or acute myocardial infarction underwent DCA. Cryostat sections of atherectomy specimen were immunohistochemically stained with the monoclonal antibodies a -actin (smooth muscle cells; SMC), CD-68 (macrophages; MAC), CD-3 (T-cells) and C3/43 (HLA-DR molecules; HLA) for recognition of plaque inflammation. A quantitative measure of plaque inflammation was planimetrically assessed as the percentage immunopositive tissue area of the total tissue area. T-cells were counted and expressed per mm2. Patients were followed for 8 years to document death, acute (AMI, UA) and stable (PCI, CABG) coronary syndromes (CS).
Results: A total of 66 acute and 41 stable CSs occurred in 73 patients. A total of 32 patients died. A best cut off value for MAC for prediction of death, using the receiver operating curve, was determined at 13,7 %. The survival curve below shows a strong prediction for death for patients with > 13,7 % plaque MACs. Furthermore, in 23 patients more than one CS occurred. There was a positive relation between plaque inflammation and the sum of acute CSs (MAC; p=0,0001, T-cells; p=0,0068, HLA; p=0,049).
Conclusion: The extent of initial plaque inflammation is associated with frequent future acute coronary syndromes and a strong predictor for death. These results suggest an ongoing inflammatory process responsible for recurrent plaque destabilization underlying new acute coronary syndromes and death at long term follow up.