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ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 1-7

Atherosclerotic plaque composition and significance of nonculprit intermediate coronary lesions. Intravascular ultrasound and quantitative coronary angiography study in acute coronary syndrome


Department of Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Helmy H El Ghawaby
Department of Critical Care, Faculty of Medicine, Cairo University, Cairo, 11562
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_14_17

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Background Detection of potentially vulnerable plaques inducing acute coronary syndrome (ACS) improves prevention of cardiovascular events. We aimed at using intravascular ultrasound (IVUS) for morphological assessment, anatomical significance of atherosclerotic plaques of nonculprit intermediate coronary lesions and correlation with quantitative coronary angiography (QCA) in ACS. Patients and methods 2IVUS was performed on 61 nonculprit intermediate coronary lesions in 28 patients diagnosed with non-ST-elevation ACSs. Percent area stenosis more than 70% was the cutoff value for intervention. Results The mean age was 53.2±9.1 years, men=20 (71.4%). Culprit vessels represent 42% of affected vessels. Higher lipid content was found in lesions of culprit vessels (P<0.001). Six lesions were revascularized based on IVUS measures (QCA accuracy=90.1%, sensitivity=77.8%, and negative predictive value=85%). Minimal lumen area (MLA) and plaque burden are the main predictors for lesion anatomical significance with [P<0.001, odds ratio=0.25, 95% confidence interval (CI)=0.12–0.55] and (P=0.011, odds ratio=2.0, 95%CI=1.2–3.3), respectively. There was a positive strong correlation between QCA minimal lumen diameter and MLA (P<0.001, r=0.695). An inverse moderate correlation was seen between QCA minimal lumen diameter and percent area stenosis (P<0.001, r=−0.449). There was a significant concordance between QCA and IVUS regarding percent stenosis (P=0.01, intraclass correlation coefficient=0.451, 95%CI=0.084–0.67), while there was disconcordance in measurement of the lesion length (P=0.2, intraclass correlation coefficient=0.22, 95%CI=−0.3–0.53). Conclusion IVUS might be valuable for the assessment of nonculprit lesions in ACS. There is high vulnerability for plaque rupture in intermediate lesions of culprit vessels. MLA and plaque burden are the main predictors for lesion anatomical significance. QCA is a reliable tool for detecting severity of coronary artery disease.


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