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Differences in intravascular ultrasound and histological findings in culprit coronary plaques between ST-segment elevation myocardial infarction and stable angina

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Abstract

A comprehensive evaluation of culprit coronary lesions may help to understand vulnerable plaques responsible for ST-segment elevation myocardial infarction (STEMI). We compared intravascular ultrasound (IVUS) and histological findings in culprit coronary plaques from 94 patients with STEMI (n = 54) or stable angina (n = 40). Tissue specimens were obtained by directional coronary atherectomy and IVUS was performed before percutaneous coronary intervention. IVUS and histological data were analyzed. Clinical characteristics were largely similar between the two groups. Plaque rupture and thrombi were more frequently found in the STEMI group than in the stable angina group. There were no significant differences between plaque types or proximal and distal reference measurements in the two groups. However, the site of minimal lumen area had a greater vessel area, remodeling index, and plaque burden with lesser lumen area in the STEMI group than in the stable angina group. Plaque areas immunopositive for CD68 and CD31 were significantly larger in the STEMI group, while the area immunopositive for α-smooth muscle actin was larger in the stable angina group. In conclusion, culprit lesions in STEMI patients showed a greater plaque burden, remodeling index, and more frequent thrombi with increased inflammation and neovascularization compared to the stable angina group, supporting the current concept of vulnerable plaques being responsible for STEMI.

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Acknowledgments

This study was supported by a grant from the CardioVascular Research Foundation, and the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (H13C1371).

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Authors and Affiliations

  1. Department of Medicine, University of Ulsan, Seoul, Korea

    Cheol Whan Lee, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park & Seung-Jung Park

  2. Department of Pathology, School of Medicine, Keimyung University, 194 Dongsan-Dong, Choong-Ku, Taegu, Korea

    Ilseon Hwang

  3. Department of Pathology, Asan Medical Center, University of Ulsan, Seoul, Korea

    Chan-Sik Park

  4. Asan Institute of Life Sciences, University of Ulsan, Seoul, Korea

    Hyangsin Lee

  5. Division of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea

    Seung-Jung Park

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  1. Cheol Whan Lee
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  2. Ilseon Hwang
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  3. Chan-Sik Park
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  4. Hyangsin Lee
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  7. Seung-Whan Lee
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Corresponding author

Correspondence to Seung-Jung Park.

Additional information

Cheol Whan Lee and Ilseon Hwang have contributed equally to this paper.

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Lee, C.W., Hwang, I., Park, CS. et al. Differences in intravascular ultrasound and histological findings in culprit coronary plaques between ST-segment elevation myocardial infarction and stable angina. J Thromb Thrombolysis 37, 443–449 (2014). https://doi.org/10.1007/s11239-013-0975-z

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