Abstract 517: Diabetic Status Is More Predictive of Necrotic Core Burden in Acute Coronary Syndrome Patients Versus Stable Patients Undergoing Percutaneous Coronary Intervention as Quantified by Intravascular Ultrasound Virtual Histology
Background: ACS plaque is thought to differ from non-ACS plaque by manifesting more inflammation / cellular debris and lower plaque volume. We used intravascular ultrasound-Virtual Histology (IVUS-VH) to validate reported plaque compositional differences pre- PCI in ACS vs. non-ACS patients (pts).
Methods: 2,579 IVUS-VH frames were acquired in 36 PCI pts (ACS: n = 15, 6 diabetic (DM); non-ACS: n = 21, 9 DM). Automated IVUS-VH pullbacks were performed using Volcano EagleEye Platinum 20 MHz probes with VH frames traced and blindly adjudicated. VH data was divided into Fibrous (FI), Fibro-Fatty (FF), Necrotic Core (NC), and Dense Calcium (DC). Statistical analyses were performed in groups stratified by ACS and DM status.
Results: ACS pts overall had slightly higher plaque area/frame (Fig 1) with lower proportional NC (16% vs. 21%, p <0.001) and absolute NC amount (1.6 vs. 1.9 mm2, p<0.0001) than non-ACS pts. NC/DC ratio, a known VH correlate of lesion instability, was higher however (3.2 vs. 1.9, P<0.0001) in ACS pts. DM status conferred opposite NC content signals when pts were divided by ACS status, with DM/ACS plaque having the greatest NC content of all. (Fig.1)
Conclusions: ACS plaque does not uniformly contain greater NC but does evidence greater NC/DC ratio suggesting increased overall plaque vulnerability. DM status is more predictive of absolute NC burden in ACS patients than non-ACS patients. This raises the question of whether the impact of DM on NC content eclipses the impact of ACS and merits further study.
- © 2012 by American Heart Association, Inc.