Abstract 10439: Natural History of Echolucent Plaque in Stable Patients with Coronary Artery Disease: Insights From Intravascular Ultrasound
Background: Large lipid cores are frequently found in vulnerable plaques with a high propensity to rupture and promote acute ischemia. Echolucent plaques (ELP) reflecting lipid cores are often observed in patients with acute coronary syndromes undergoing intravascular ultrasound (IVUS). The presence and implications of ELPs in patients with stable disease has not been characterized.
Methods: 582 statin naïve patients with coronary artery disease who were subsequently treated with a statin underwent serial IVUS imaging. The prevalence of ELPs (≥3 consecutive images with intraplaque areas of low echogenicity with a thickness >0.3mm and no attenuation or acoustic shadowing) was determined. Clinical characteristics and atheroma progression in patients with (n=56) and without (n=526) at baseline were investigated.
Results: ELPs were found in 9.6% of patients. Patients with an ELP were more likely to be smokers (21 vs 36%, p=0.02) and have a history of myocardial infarction (21 vs 37%, p=0.01). These patients also harbored more extensive atherosclerosis with a greater percent atheroma volume and total atheroma volume at baseline and greater disease progression on serial evaluation. Of these patients, 15 patients who did not have ELP at baseline newly developed an ELP on serial imaging. These patients were more likely to be diabetic (53 vs 31%, p<0.05) and demonstrated greater disease progression, despite similar control of blood pressure and lipids. (Table)
Conclusions: The presence or development of echolucent plaque is associated with more extensive atheroma burden and rapidly progressive disease progression. Echolucent disease indicates a patient who warrants more intensive management of risk factors.
- © 2011 by American Heart Association, Inc.