Coronary plaque tissue characterization in patients with premature coronary artery disease

Jianchang Xie,Jie Qi,Guoxin Tong,Liang Zhou,Hao Pan,Jinyu Huang,Xianhua Ye,Ningfu Wang,Hengyi Mao,Jianmin Yang

doi:10.1007/s10554-020-01794-9

Abstract

Premature coronary artery disease (CAD) studies rarely involve coronary plaque characterization. We characterize coronary plaque tissue by radiofrequency intravascular ultrasound (IVUS) in patients with premature CAD. From July 2015 to December 2017, 220 patients from the Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine with first occurrence of angina or myocardial infarction within 3 months were enrolled. Patients with premature CAD (n = 47, males aged < 55 years, and females aged < 65 years) or later CAD (n = 155) were retrospectively compared for cardiovascular risk factors, laboratory examination findings, coronary angiography data, gray-scale IVUS, and iMap-IVUS. The mean age was 53.53 ± 7.24 vs. 70.48 ± 8.74 years (p < 0.001). The groups were similar for traditional coronary risk factors except homocysteine (18.60 ± 5.15 vs. 17.08 ± 4.27 µmol/L, p = 0.043). After matching for baseline characteristics, LDL cholesterol (LDL-C) was higher for premature CAD than later CAD (2.50 ± 0.96 vs. 2.17 ± 0.80 mmol/L, p = 0.019). Before the matching procedure, the premature CAD group had shorter target lesion length [18.50 (12.60–32.00) vs. 27.90 (18.70–37.40) mm, p = 0.002], less plaque volume [175.59 (96.60–240.50) vs. 214.73 (139.74–330.00) mm3, p = 0.013] than the later CAD group. After the matching procedure, the premature CAD group appeared to be less plaque burden (72.69 ± 9.99 vs. 74.85 ± 9.80%, p = 0.005), and positive remodeling (1.03 ± 0.12 vs. 0.94 ± 0.18, p = 0.034), and lower high risk feature incidence (p = 0.006) than the later CAD group. At the plaque’s minimum lumen, premature CAD had more fibrotic (p < 0.001), less necrotic (p = 0.001) and less calcified areas (p = 0.012). Coronary plaque tissue was more fibrotic with less necrotic and calcified components in premature than in later CAD, and the range and degree of atherosclerosis were significantly lower.

Highlights

Coronary artery disease (CAD) is the leading cause of mortality and much is known about the causes and risk factors for the disease [1]
The patients were grouped into the premature CAD group and later CAD groups according to their age at diagnosis
From the 220 patients selected for inclusion in the study, 18 patients were excluded for in-stent restenosis, vision thrombus with angiographically, and an inadequate imaging quality

Summary

Introduction

Coronary artery disease (CAD) is the leading cause of mortality and much is known about the causes and risk factors for the disease [1]. Coronary angiography is a well-established diagnostic modality for percutaneous coronary intervention (PCI) guidance, but more recent intravascular imaging techniques enhance the efficacy of lesion evaluation [10]. Intravascular ultrasound (IVUS) has been developed to access plaque composition and define atherosclerotic lesion phenotype [13]. Based on pattern recognition of the RF signals, iMap-IVUS (Boston Scientific, Marlborough, MA) can provide quantitative analysis of plaque composition and classify them to four tissue types (fibrotic, lipidic, necrotic, and calcified) in vivo [14, 15]

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