Abstract 10006: Remnant Lipoproteinemia is a Risk of Non-Culprit Attenuated Coronary Plaques Detected by Grayscale Intravascular Ultrasound in Patients with Acute Coronary Syndromes
Patients with acute coronary syndromes (ACS) have vulnerable coronary plaques not only in the culprit lesion, but also in non-culprit lesions. The attenuated coronary plaques (hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium) detected by gray-scale intravascular ultrasound (IVUS) are associated with a high rate of no-reflow or deterioration in coronary flow during percutaneous coronary intervention (PCI). We have previously reported that high serum levels of remnant lipoproteins predict coronary events in patients with coronary artery disease (CAD). This study examined whether high remnant levels may be a risk of the attenuated plaques detected by IVUS in non-culprit vessel in ACS.
Methods: A multicenter prospective enrollment of patients receiving PCI in Yamanashi area (FUJISUN registry) was conducted from May 2008. Among 1454 patients enrolled in our registry, 601 ACS patients who received IVUS examination of both culprit and non-culprit vessels were included in this study. We investigated the attenuated plaque of angiographically moderate - high grade of obstructive lesions in non-culprit vessel at the PCI of culprit lesion using gray-scale IVUS. Serum levels of remnant lipoproteins were measured by an immunoseparation method (remnant-like-lipoprotein-particles cholesterol; RLP-C).
Results: The attenuated plaque in non-culprit vessel was detected in 57 (9.4%) patients. The attenuated plaque was shown in 33 (14.9%) of 221 patients with high RLP-C levels (≥ 5.0 mg/dL, 75th percentile of the distribution of 100 control subjects) and in 24 (6.3%) of 380 patients with RLP-C levels < 5.0 mg/dL (p < 0.001). In multivariate logistic regression analysis, high RLP-C levels were a significant risk factor of the presence of the attenuated plaque in non-culprit vessel of ACS patients (OR 2.2, 95%CI 1.2 - 4.0, p < 0.01), that was independent of high levels of HbA1c, CRP and triglyceride, multivessel CAD and the Framingham risk score variables.
Conclusions: High remnant lipoproteins levels are associated with the attenuated plaque detected by IVUS in non-culprit vessel in ACS patients. This could have therapeutic implications in the setting of multivessel PCI in ACS patients with high levels of remnant lipoproteins.
- Acute coronary syndromes
- Intravascular ultrasound/Doppler
- Percutaneous coronary intervention
- Vulnerable plaque
- © 2011 by American Heart Association, Inc.