Comparison of coronary plaque composition among patients with acute coronary syndrome and stable coronary artery disease

Background The identification of vulnerable plaques before rupture is an important clinical goal.The purpose of thepresent study was to assess the difference in plaque composition among patients with acute coronary syndrome(ACS)and stable coronary artery disease(SCAD)by intravascular ultrasound virtual histologic analysis.Methods One hundred and thirty-nine patients were divided into ACS group and SCAD group according to clinicalpresentation.A total of 229 de novo lesions with>50% stenosis in native coronary arteries with diameters>2.5 mm werestudied with intravascular ultrasonography.Geometric and compositional data were obtained using intravascularultrasound virtual histology software.Results There were no significant differences in overall lesions for fibrous((52.0±11.9)% vs(54.3±8.5)%,P>0.05),fibrolipidic((12.3±10.1)% vs(13.8±9.5)%,P>0.05),calcium((14.0±9.1)% vs(19.3±13.1)%,P>0.05),or necrotic core((22.0±11.1)% vs(19.7±5.4)%,P>0.05)percentages in ACS and SCAD patients,respectively.There were also nosignificant differences in culprit lesions for fibrous((46.4±12.0)% vs(53.6±8.8)%,P>0.05),fibrolipidic((9.1±9.0)% vs(12.9±9.7)%,P>0.05),calcium((16.6±9.7)% vs(21.8±26.3)%,P>0.05),or necrotic core((28.0±12.6)% vs(20.6±5.2)%,P>0.05)percentages in ACS and SCAD patients,respectively.High density lipoprotein-cholesterol levels>1.04 mmol/Lwere associated with more fibrolipidic((14.5±10.4)% vs(7.1±6.5)%,P<0.05)and less necrotic core((20.6±9.7)% vs(27.9±12.6)%,P<0.05)percentages in the cohort with ACS.Conclusions In this study,coronary plaque composition assessed by intravascular ultrasound virtual histologicanalysis was not significantly different between ACS and SCAD patients.The anatomic relationship of the specific plaquecomponents to the lumen of the vessel was more important than the quantitative information of plaque composition forplaque stability.