Body mass index, carotid plaque, and clinical outcomes in patients with coronary artery disease.

OBJECTIVES: We evaluated the relationship among BMI, carotid sonographic findings, and long-term (5 years) cardiovascular events in Asian patients with coronary artery disease (CAD). PATIENTS AND METHODS: The study population consisted of 1342 consecutive patients with CAD, who were stratified into four groups according to weight status, as defined by the WHO for the Asian population: underweight (group I: BMI<18.5 kg/m, n=38); normal weight (group II: 18.5≤BMI<23.5 kg/m, n=352); overweight (group III: 23.5≤BMI<27.5 kg/m, n=700); and obese (group IV: BMI≥27.5 kg/m, n=252). All patients underwent carotid ultrasonography. Multivariate analysis was performed to identify predictors of long-term mortality, and the results were expressed in terms of hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: Compared with the other groups, groups I and II included older patients and had a higher incidence of multivessel CAD, carotid plaque (group I: 42.1%; group II: 42.3%; group III: 27.9%; group IV: 24.6%; P=0.003), and major cardiovascular events including cardiac death, acute myocardial infarction, and stroke. In multivariate analysis, old age, lower ejection fraction, high carotid intima-media thickness, and presence of carotid plaque were positive independent predictors for mortality, whereas BMI was a negative independent predictor (group II: HR=0.28, 95% CI=0.14-0.57, P<0.001; group III: HR=0.26, 95% CI=0.13-0.51, P<0.001; group IV: HR=0.08, 95% CI=0.03-0.22, P<0.001). CONCLUSION: In patients with CAD, underweight and normal-weight status was associated with higher long-term mortality rates and incidence of major cardiovascular events, suggesting that the obesity paradox is also manifested in Asian patients with CAD.

Carotid plaque is associated with increased cardiac mortality in patients with coronary artery disease.

BACKGROUND: It is still controversial whether carotid plaque is associated with cardiovascular events in patients with coronary artery disease (CAD). The aim of the present study is to evaluate the impact of carotid plaque on long term clinical outcomes especially in patients with CAD. METHODS: The study population consisted of 1390 consecutive patients with angiographically proven CAD. All subjects underwent carotid scanning 1 day before or after coronary angiogram and were followed up for major adverse cardiovascular events (MACE; death, myocardial infarction, stroke, revascularization, restenosis and hospitalization for heart failure) during a mean of 54.2 ± 23.9 months. RESULTS: Patients with carotid plaque (n=433) were older, had higher prevalence of cardiovascular risk factors and acute coronary syndrome (34.2% vs. 24.6%, p<0.001) than those without carotid plaque (n=957). On univariate analysis, the presence of carotid plaque was a predictor of cardiac death, hard MACE (death, myocardial infarction and stroke) and total MACE, whereas carotid intima-media thickness (CIMT) was a predictor of total MACE. Multivariate analysis revealed that carotid plaque was associated with cardiac death (HR 6.99, 95% CI 1.88-25.95, p=0.004), hard MACE (HR 1.89, 95% CI 1.18-3.04, p=0.008) and total MACE (HR 1.47, 95% CI 1.13-1.90, p=0.004), whereas CIMT was associated only with total MACE (HR 1.39, 95% CI 1.06-1.81, p=0.017). CONCLUSIONS: Carotid plaque is a strong predictor of future cardiac death and MACE in patients with CAD. This study suggests that carotid plaque has additional value for secondary prevention and more important prognostic factor than CIMT in patients with CAD.

Discrepancy of calcium detection between gray scale intravascular ultrasound and spectral analysis of radiofrequency data.

BACKGROUND: We evaluated discrepancy of calcium detection between gray scale intravascular ultrasound (IVUS) and virtual histology (VH)-IVUS and the association between coronary calcium and plaque composition. METHODS: Study population consisted of 162 consecutive patients who underwent percutaneous coronary intervention with VH-IVUS study. Subjects were divided into 3 groups based on gray scale IVUS findings; No calcification group (n=50), spotty group (n=56) who had a lesion containing only small calcium deposits within an arc <90° and diffuse group (n=56) who had a diffuse calcified lesion with an arc ≥ 90° in ≥ 1 cross-sectional image of the lesion. RESULTS: No calcification group was younger than spotty and diffuse groups (54.4 ± 13.0 years vs. 61.1 ± 10.7 years and 64.2 ± 9.9 years, p=0.011 and p<0.001, respectively). No calcification group had some degree of dense calcium (5. 7 ± 6.9 mm(3)) by VH-IVUS analysis. Furthermore, calcified volume by VH-IVUS in no calcification group was similar to those in spotty group (5.7 ± 6.9 mm(3) vs. 5.4 ± 4.4mm(3)). Dense calcium volume was correlated directly with plaque volume (r=0.65, p<0.001), fibrous volume (r=0.54, p<0.001), fibro-fatty volume (r=0.29, p<0.001) and lipid core volume (r=0.77, p<0.001). In multiple regression analysis, lipid core volume (ß=0.287, 95% confidence interval (CI) 0.187-0.388, p<0.001) was an independent predictor of dense calcium volume. CONCLUSIONS: This study showed that coronary calcium can be present even if invisible in gray scale IVUS and associated with lipid core volume, which is a characteristic of plaque vulnerability.

Impact of plaque composition on long-term clinical outcomes in patients with coronary artery occlusive disease.

BACKGROUND AND OBJECTIVES: It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. SUBJECTS AND METHODS: The study subjects consisted of 339 consecutive patients (mean 61.7±12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. RESULTS: Patients with high fibrofatty volume (FFV, >8.90 mm(3), n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV≤8.90 mm(3), n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE. CONCLUSION: FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.

Fibro-Fatty Component is Important for the Long-Term Clinical Events in Patients Who Have Undergone Primary Percutaneous Coronary Intervention.

BACKGROUND AND OBJECTIVES: We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study subjects consisted of 57 consecutive patients (mean age, 58.5±14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period. RESULTS: Patients with high fibro-fatty volume (FFV >13.4 mm(3), n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm(2) vs. 15.9 mm(2), p<0.001), and larger plaque volume (315 mm(3) vs. 142 mm(3), p<0.001) than those with a low FFV (≤13.4 mm(3), n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population. CONCLUSION: The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.