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Histopathologic Characteristics of Atherosclerotic Coronary Disease and Implications of the Findings for the Invasive and Noninvasive Detection of Vulnerable Plaques

Journal of the American College of Cardiology, 2013-03, Vol.61 (10), p.1041-1051 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2013 American College of Cardiology Foundation ;2014 INIST-CNRS ;Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Mar 12, 2013 ;2013 by the American College of Cardiology Foundation 2013 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2012.10.054 ;PMID: 23473409 ;CODEN: JACCDI

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Title:
Histopathologic Characteristics of Atherosclerotic Coronary Disease and Implications of the Findings for the Invasive and Noninvasive Detection of Vulnerable Plaques
Author: Narula, Jagat, MD, PhD ; Nakano, Masataka, MD, PhD ; Virmani, Renu, MD ; Kolodgie, Frank D., PhD ; Petersen, Rita, MS ; Newcomb, Robert, PhD ; Malik, Shaista, MD, PhD ; Fuster, Valentin, MD, PhD ; Finn, Aloke V., MD
Subjects: acute coronary syndrome ; Acute coronary syndromes ; Adult ; Aged ; Aged, 80 and over ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Calcification ; Cardiology. Vascular system ; Cardiovascular ; coronary artery disease ; Coronary Artery Disease - pathology ; Coronary heart disease ; Coronary Stenosis - pathology ; Coronary vessels ; Coronary Vessels - pathology ; Female ; Fibrosis ; Heart ; Heart attacks ; high-risk plaque ; Humans ; Inflammation - pathology ; Internal Medicine ; Macrophages - pathology ; Male ; Medical sciences ; Methods ; Middle Aged ; Myocardium - pathology ; Necrosis ; Plaque, Atherosclerotic - pathology ; positive remodeling ; Severity of Illness Index ; Trends ; Veins & arteries
Is Part Of: Journal of the American College of Cardiology, 2013-03, Vol.61 (10), p.1041-1051
Description: Objectives The goal of this study was to identify histomorphologic characteristics of atherosclerotic plaques and to determine the amenability of some of these components to be used as markers for invasive and noninvasive imaging. Background Rupture of the atherosclerotic plaques is responsible for the majority of acute coronary events, and the culprit lesions demonstrate distinct histopathologic features. It has been tacitly believed that plaque rupture (PR) is associated with angiographically minimally occlusive lesions. Methods We obtained 295 coronary atherosclerotic plaques, including stable (fibroatheroma [FA]; n = 105), vulnerable (thin-cap fibroatheroma [TCFA]; n = 88), and disrupted plaques (plaque rupture [PR]; n = 102) from the hearts of 181 men and 32 women who had died suddenly. The hierarchical importance of fibrous cap thickness, percent luminal stenosis, macrophage area, necrotic core area, and calcified plaque area was evaluated by using recursive partitioning analysis. Because clinical assessment of fibrous cap thickness is not possible by noninvasive imaging, it was excluded from the second set of partitioning analysis. Results Thickness of the fibrous cap emerged as the best discriminator of plaque type; the cap thickness measured <55 μm in ruptured plaques, and all FA were associated with >84-μm cap thickness. Although the majority of TCFA were found in the 54- to 84-μm thickness group, those with <54-μm thickness were more likely to show <74% luminal stenosis (area under the curve: FA, 1.0; TCFA, 0.89; PR, 0.90). After exclusion of cap thickness, analysis of the plaque characteristics revealed macrophage infiltration and necrotic core to be the 2 best discriminators of plaque types (area under the curve: FA, 0.82; TCFA, 0.58; PR, 0.72). More than 75% cross-section area stenosis was seen in 70% of PR and 40% of TCFA; only 5% PR and 10% TCFA were <50% narrowed. Conclusions This postmortem study defines histomorphologic characteristics of vulnerable plaques, which may help develop imaging strategies for identification of such plaques in patients at a high risk of sustaining acute coronary events.
Publisher: New York, NY: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2012.10.054
PMID: 23473409
CODEN: JACCDI
Source: Geneva Foundation Free Medical Journals at publisher websites
MEDLINE
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Histopathologic Characteristics of Atherosclerotic Coronary Disease and Implications of the Findings for the Invasive and Noninvasive Detection of Vulnerable Plaques

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