Analgesic effect of acupuncture in patients with stable angina: integrative review / Efeito analgésico da acupuntura em pacientes com angina estável: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Angina is a clinical syndrome characterized by pain or discomfort, considered stable when it occurs for several weeks without progressing to an acute coronary event. Anginal pain management can be performed with pharmacological and non-pharmacological treatments, among which acupuncture is a non-pharmacological option. The aim of this study was to carry out an integrative review of the analgesic effect of acupuncture in patients with stable angina. CONTENTS: An integrative review was carried out in April 2021 in databases: Pubmed, Scopus, Cinahl and Bireme. Controlled descriptors "angina pectoris", "angina stable", "acupuncture", "acupuncture therapy", "acupuncture analgesia" were used. After screening and analyzing the manuscripts, seven experimental studies of the randomized controlled trial type were selected. The results suggest that acupuncture in patients with stable angina can promote an analgesic effect with clinical improvement of symptoms. CONCLUSION: Acupuncture can be an adjuvant therapeutic alternative for the treatment of patients with stable angina, since it can promote an analgesic effect with clinical improvement of symptoms.

RESUMO JUSTIFICATIVA E OBJETIVOS: A angina é uma síndrome clínica caracterizada por dor ou desconforto, considerada estável quando ocorre por várias semanas sem evoluir para um evento coronariano agudo. O manejo da dor anginosa pode ser realizado por meio de tratamentos farmacológicos e não farmacológicos, incluindo a acupuntura como uma opção não farmacológica complementar. O objetivo deste estudo foi realizar uma revisão integrativa sobre o efeito analgésico da acupuntura em pacientes com angina estável. CONTEÚDO: Foi realizada uma revisão integrativa no mês de abril de 2021 nas bases de dados: Pubmed, Scopus, Cinahl e Bireme. Foram utilizados os descritores controlados "angina pectoris", "angina stable", "acupuncture", "acupuncture therapy", "acupuncture analgesia". Após triagem e análise dos manuscritos, foram selecionados sete estudos experimentais do tipo ensaio controlado randomizado. Os resultados sugerem que a acupuntura pode promover efeito analgésico com melhora clínica dos sintomas em pacientes com angina estável. CONCLUSÃO: A acupuntura pode ser uma alternativa terapêutica complementar para tratamento de pacientes com angina estável, uma vez que pode promover efeito analgésico com melhora clínica dos sintomas.

Clinical observation of Guanxin Tongmai plaster combined with medicine in the treatment of stable angina pectoris of coronary heart disease / 国际中医中药杂志

Objective:To evaluate the clinical effect of Guanxin Tongmai plaster combined with conventional western medicine in the treatment of phlegm and blood stasis syndrome of coronary heart disease and angina pectoris.Methods:A total of 60 patients in the Department of Cardiology of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine (TCM) from February to August 2020 who met the inclusion criteria were randomly divided into two groups with 30 in each group. Both groups were treated with conventional western medicine. On this basis, Guanxin Tongmai plaster was applied at the acupoints in the treatment group and placebo plaster was applied in the control group. TCM syndrome score was performed before and after treatment, angina score was evaluated from three aspects of angina attack frequency, duration and pain degree, and blood lipid TG, TC, LDL-C and HDL-C were detected by enzyme quantitative method. The blood homocysteine (Hcy) was detected by enzyme circulation method, the ECG and the nitroglycerin reduction rate were recorded, and the safety index was detected according to the ECG changes.Results:In the treatment period, 2 patients in the treatment group fell off, 3 in the control group. A total of 28 patients in the treatment group and 27 in the control group were analyzed. The total effective rate of ECG efficacy in the treatment group was 67.9% (19/28) and the control group was 48.1% (13/27). There was significant difference between the two groups ( χ2=4.46, P=0.040). After treatment, the TCM syndrome score and angina score in the treatment group were significantly lower than those in the control group ( t values were 9.12 and 4.45, P values were 0.004 and 0.042, respectively). The reduction rate of nitroglycerin in the treatment group was 82.1% (23/28) and 55.6% (15/27) in the control group. There was significant difference between the two groups ( χ 2=4.72, P=0.030). After treatment, the plasma TG, TC, LDL-C in the treatment group were significantly lower than those in the control group ( t values were 4.17, 6.57 and 6.52, P<0.05 or P<0.01), the level of HDL-C was significantly higher than that of the control group ( t=7.07, P=0.010), and the level of plasma Hcy was significantly lower than that in the control group ( t=6.70, P=0.012). There was no significant difference in liver, kidney and coagulation function between the two groups. Conclusion:Guanxin Tongmai plaster combined with conventional western medicine can improve the clinical symptoms of patients with coronary heart disease and angina pectoris, reduce the level of blood lipid and Hcy, and improve the clinical curative effect.

Critical analysis of the classic indications for myocardial revascularization

SUMMARY Treatment of stable coronary artery disease (CAD) relies on improved prognosis and relief of symptoms. National and international guidelines on CAD support the indication of revascularization in patients with limiting symptoms and refractory to optimal medical treatment, as well as in clinical situations where there is a prognostic benefit of interventional treatment. Most of the studies that support the guidelines for indication of revascularization date back to the 1980s and1990s of the last century. Recent studies have revisited the theme and brought a new breath. The present review provides a critical analysis of classic indications for revascularization, reviewing evidence from the studies of the 1970s to the recent controversial ORBITA study.

RESUMO O tratamento da doença arterial coronariana estável (DAC) se baseia na melhora do prognóstico e alívio de sintomas. Diretrizes nacionais e internacionais sobre a DAC respaldam a indicação de revascularização em pacientes com sintomas limitantes e refratários ao tratamento medicamentoso, bem como em situações clínicas nas quais há benefício prognóstico do tratamento intervencionista. Grande parte dos estudos que norteiam as diretrizes de indicação de revascularização data das décadas de 1980 e 1990. Estudos recentes têm revisitado o tema e trazido novo fôlego. A presente revisão faz uma análise crítica das indicações clássicas de revascularização, revisando a evidência desde os estudos da década de 1970 ao recente e polêmico estudo Orbita.

Effect of Tongbi decoction on endothelial function and hemorheology in patients with coronary heart disease with angina pectoris / 国际中医中药杂志

Objective To observe the effect of Tongbi decoctionon for the changes of the endothelial function and hemorheology in patients with coronary heart disease. Methods A total of 90 patients with angina pectoris were divided into the observation group and the control group according to the random number table method, with 45 in each group. The control group was given routine clinical treatment, and the observation group was treated with Tongbi decoction on the basis of the control group. After treated for 4 weeks, the pain severity of angina pectoris was observed before and after treatment, and the frequency and duration of angina pectoris were recorded. The levels of serum vascular endothelin (ET) and endothelin (VEGF) were measured by ELISA. The serum NO was measured by nitrate reductase method, and whole blood viscosity and plasma viscosity were measured by blood viscometer. The hematocrit was measured by hematocrit analyzer and optical density method. The erythrocyte aggregation index was measured, and the fibrinogen level was measured by heating precipitation method. And the clinical efficacy was evaluated. Results After treatment, the total effective rate was 93.3％ (42/45) in the observation group and 77.8％ (35/45) in the control group, and there was significant difference between the two groups (Z=-3.164, P=0.002). After treatment, the score of angina pain (0.62 ± 0.05 vs. 1.17 ± 0.14, t=5.733) , the frequency of angina attack (3.62 ± 0.43 times/week vs. 5.02 ± 0.64 times/week, t=5.042), the duration of angina attack (3.17 ± 0.42 minutes/time vs. 4.06 ± 0.51 minutes/time, t=4.781) in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of VEGF and NO in the observation group were significantly higher than those in the control group (t value was 5.892, 5.347, all Ps<0.05), and ET was significantly lower than that in the control group (t=4.926, P=0.037). After treatment, the whole blood viscosity, plasma viscosity, hematocrit, aggregation index and fibrinogen levels in the observation group were significantly lower than those in the control group (t values were 4.832, 4.233, 5.031, 4.136, 4.531, all Ps<0.05). Conclusions The application of Tongbi decoction can improve the endothelial function of patients with angina pectoris, adjust the hemorheological indexes and relieve the symptoms related to angina pectoris.

On-Pump beating/non-beating cabg in stable angina have similar outcomes

Abstract Objective: On pump beating/non-beating coronary artery bypass grafts (CABG) has been compared in patients with unstable angina and/or severe left ventricular dysfunction. There is scarce evidence regarding the beneficial use of on-pump beating CABG in patients with stable angina and normal left ventricular function. Our aim was to study the postoperative results using both techniques in this group of patients. Methods: One thousand one hundred and forty-five patients with stable angina underwent on-pump isolated CABG in Uruguay from 2011 to 2015. Patients were grouped into beating/non-beating CABG. Operative mortality and long-term survival were evaluated as primary outcome. Logistic regression analysis was performed to define the predictive role of aortic cross clamp (AXC) on prolonged inotropic support, ventilator support and intraoperative glycemia. Results: Among the included patients, 988 underwent aortic cross clamp. No differences were found in operative mortality, stroke and long-term survival among both groups. Patients without AXC showed higher intraoperative values of glycemia and higher incidence of postoperative prolonged mechanical ventilator support (7.6% vs. 2.4%; P=0.001). The need for prolonged inotropic support was lower in this group of patients (27.4% vs. 49.5%; P<0.001). Conclusion: On-pump beating CABG has similar operative mortality and long-term survival compared with conventional AXC. Higher intraoperative glycemia and higher incidence for prolonged mechanical ventilator is associated with on-pump beating CABG. On the contrary, higher incidence for prolonged inotropic support is associated with AXC. Taking these factors into consideration, both techniques are safe and allow the surgeon to choose the most comfortable option.

CANG and preoperative use of beta-blockers in patients with stable angina are associated with better cardiovascular survival

Abstract Objective: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. Methods: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. Results: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. Conclusion: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.

Correlation between treadmill exercise test assessing myocardial ischemia and coronary stenosis / 心血管康复医学杂志

Objective :To study correlation between treadmill exercise test assessing myocardial ischemia and coronary stenosis .Methods :A total of 150 patients with stable angina pectoris in our hospital ,according to vascular stenosis by coronary CT were divided into group A (stenosis＜ 50%,n＝ 50) ,group B (stenosis 50% ～75%,n＝ 50) and group C (stenosis ＞75%,n＝50).Coronary stenotic rate and ST depression during exercise test were compared a-mong three groups.Spearman method was used to analyze correlation between treadmill exercise positive rate and coronary stenosis .Results :Compared with group B ,there were significant rise in coronary diameter stenotic rate [(63.64 ± 4.21)% vs.(66.71 ± 4.46)%] and vascular diameter of reference segment [(2.92 ± 0.23) mm vs.(3.03 ± 0.21) mm] in group C ,P＜0.05 or ＜0.01. Along with coronary stenosis aggravated ,there was significant re-duction in onset time of ST depression [(712.3 ± 202.7) s vs.(602.3 ± 210.4) s vs.(501.2 ± 236.1) s] ,and signif-icant rise in duration [ (425.4 ± 200.5) s vs.(520.8 ± 205.8) s vs.(603.4 ± 198.4) s] and treadmill exercise posi-tive rate (64.00% vs.82.00% vs .92.00%) ,in group A ,B ,C respectively ;and ST depression extent of group C was significantly higher than that of group A [(2.4 ± 1.1) mV vs.(1.9 ± 0.8) mV] ,P＜0.05 or ＜0.01. Spearman correlation analysis indicated that treadmill exercise positive rate (myocardial ischemia rate ) was not significantly correlated with coronary stenotic degree (r＝3.425 , P＝0.126).Conclusion :Although treadmill exercise test pos-sesses important significance in diagnosis of myocardial ischemia ,but coronary stenotic degree is not correlated with myocardial ischemic degree .which should raise clinical attention

Therapeutic effect and safety of oral musk Baoxin pill in patients with stable angina pectoris of coro-nary heart disease / 心血管康复医学杂志

Objective:To explore therapeutic effect and safety of oral musk Baoxin pill in patients with stable angina pectoris (SAP) of coronary heart disease (CHD).Methods:A total of 158 SAP patients of CHD treated in our hos-pital were selected,and were randomly divided into routine treatment group (n＝79) and musk Baoxin pill group (n＝79,received musk Baoxin pill based on routine treatment ),both groups were treated for eight weeks.Therapeutic effect and safety were compared between two groups.Results:After treatment,there was no significant difference in total effective rate of ECG improvement between two groups,P＝0.475.Compared with routine treatment group after treatment,there were significant reductions in onset times of angina pectoris [(1.68 ± 0.43) times/d vs.(1.12 ± 0.37) times/d] and nitroglycerin consumption [(1.65 ± 0.87)/d vs.(1.08 ± 0.47)/d],and significant rise in to-tal effective rate of angina pectoris improvement (81.01% vs.96.20%) in musk Baoxin pill group,P＝0.001 all.No obvious adverse reactions occurred in two groups.Conclusion:Oral musk Baoxin pill based on routine treatment can significantly relieve angina pectoris symptoms and the safety is good in patients with stable angina pectoris of coronary heart disease.

Clinical significance of sinus heart rate turbulence in aged patients with stable angina pectoris / 心血管康复医学杂志

Objective:To explore clinical significance of sinus heart rate turbulence (HRT) phenomenon in aged pa‐tients with stable angina pectoris (SAP) .Methods :A total of 120 aged SAP patients ,who received 24h DCG in our hospital from Jan 2013 to Oct 2015 ,were selected as SAP group .Meanwhile ,another 144 aged patients ,who re‐ceived 24h DCG examination simultaneously and coronary angiography results were normal ,were regarded as nor‐mal control group .According to coronary lesion severity ,SAP group was further divided into single vessel coronary disease group (single vessel group ,n=35) ,double‐vessel coronary disease group (double‐vessel group ,n=48) and multi‐vessel coronary disease group (multi‐vessel group ,n=37) .The 24h DCG ,HRT indexes ,including turbulence onset (TO) and turbulence slope (TS) ,were measured and compared among all groups .Results:Compared with normal control group ,there was significant rise in TO [(0.77 ± 0.37)% vs .(1.26 ± 0.92)% ] and significant reduc‐tion in TS [(5.45 ± 4.02) ms/RR interval vs .(1.53 ± 0.70) ms/RR interval] ,P<0.01 both ;significant rise in ab‐normal rates of TO (19.44% vs .42.50% ) ,TS (15.97% vs .31.67% ) and TO + TS (11.11% vs .30.83% ) in SAP group ,P<0.01 all .Compared with single vessel group ,there was significant rise in TO [(0.66 ± 0.22)% vs .(1.28 ± 1.11)% vs .(1.46 ± 1.20)% ] and significant reduction in TS [ (2.04 ± 0.82) ms/RR interval vs .(1.66 ± 0.38) ms/RR interval vs .(1.29 ± 0.58) ms/RR interval] in double‐vessel group and multi‐vessel group ,and TO of multi‐vessel group was significantly higher than that of double‐vessel group ,TS of multi‐vessel group was significantly low‐er than that of double‐vessel group , P<0.01 all .Conclusion:Sinus heart rate turbulence can be used as risk predic‐tor for aged patients with stable angina pectoris ,which can provide basis for clinical effective treatment and progno‐sis assessment .

Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina / Correlação entre Proteína C-Reativa em Veia Periférica e Seio Coronário na Angina Estável e Instável

Background: High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective: To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). Methods: This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results: Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Conclusion: Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA. .

Fundamento: A proteína C-reativa de alta sensibilidade (PCR-as) é comumente utilizada na prática clínica para avaliar o risco cardiovascular. Entretanto, a correlação entre os níveis séricos de PCR-as (valores absolutos) periférico versus central ainda não foi feita. Objetivo: Avaliar a correlação entre os níveis séricos de PCR-as (mg/L) em veia periférica do antebraço esquerdo (VPAE) versus seio coronário (SC), em pacientes portadores de doença arterial coronária (DAC) com diagnóstico de angina estável (AE) ou angina instável (AI). Métodos: Estudo observacional, descritivo, transversal, realizado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e no Hospital Beneficência Portuguesa de São Paulo, onde foram avaliados os pacientes encaminhados ao hospital com DAC para angiografia coronária. Resultados: Quarenta pacientes com DAC (20 AE e 20 AI) foram incluídos no estudo. Amostras de sangue na VPAE e SC foram coletadas simultaneamente antes da angiografia coronária. A análise de correlação entre os níveis séricos de PCR-as em VPAE versus SC mostrou forte correlação linear tanto para AE (r = 0,993, p < 0,001) como para AI (r = 0,976, p < 0,001) e em toda a amostra (r = 0,985, p < 0,001). Conclusão: Nossos dados sugeriram forte correlação linear entre os níveis de PCR-as em VPAE versus SC na AE e AI. .

Comparação da intervenção coronária percutânea por via radial em pacientes com doença arterial coronária estável e instável / Comparison of transradial percutaneous coronary intervention in patients with stable and unstable coronary artery disease

INTRODUÇÃO: A intervenção coronária percutânea (ICP) por via radial ainda é pouco utilizada em nosso meio. Avaliaram-se aqui os resultados da ICP por via radial, realizada em um hospital terciário, que, progressivamente, tem incorporado tal técnica à prática clínica diária. MÉTODOS: Estudo retrospectivo, de pacientes tratados entre 2007 e 2012, no Instituto Dante Pazzanese de Cardiologia. Compararam-se os perfis clínico, angiográfico e do procedimento e os resultados hospitalares dos pacientes tratados por via radial com doença arterial coronária (DAC) estável e instável. RESULTADOS: Foram incluídos 2.507 pacientes, sendo 72,6% portadores de DAC estável e 27,4% de DAC instável. Os pacientes portadores de DAC estável tinham perfil clínico mais complexo, caracterizado por serem mais idosos, mais frequentemente do sexo feminino e com maior incidência de comorbidades. As características angiográficas e do procedimento não mostraram diferenças na maioria das varáveis analisadas. A taxa de sucesso foi elevada, porém maior no grupo DAC estável (94,6% vs. 92,4%; P = 0,05). A incidência de óbito (0,2% vs. 0,3%; P = 0,61), infarto periprocedimento (4,7% vs. 6,6%; P = 0,07), acidente vascular cerebral (0,1% vs. 0,1%; P > 0,99), ICP (0,1% vs. 0,3%; P = 0,30), cirurgia de revascularização miocárdica (0 vs. 0,4%; P = 0,06), sangramento maior (0,2% vs. 0,6%; P = 0,09) ou complicação vascular (1% vs. 0,6%; P = 0,47) foi baixa e não diferiu entre os grupos. CONCLUSÕES: ICP por via radial mostrou-se segura e eficaz, tanto em pacientes com DAC estável como instável, tratados em hospital terciário que progressivamente tem incorporado essa técnica à rotina diária.

BACKGROUND: The transradial approach for percutaneous coronary intervention (PCI) is still not widely used in our country. We evaluated the results of transradial PCI performed at a tertiary hospital, which has progressively incorporated this technique to its daily clinical practice. METHODS: This is a retrospective study of patients treated from 2007 to 2012 at Instituto Dante Pazzanese de Cardiologia. Clinical, angiographic and procedural profile and in-hospital outcomes of patients with stable and unstable coronary artery disease (CAD) treated with the transradial approach were compared. RESULTS: We included 2,507 patients, of which 72.6% had stable and 27.4% had unstable CAD. Patients with stable CAD had a more complex clinical profile, characterized by being older, more frequently females, with a higher incidence of comorbidities. The angiographic and procedural characteristics were not different for most of the variables analyzed. The success rate was high, but higher in the stable CAD group (94.6% vs. 92.4%; P = 0.05). The incidence of death (0.2% vs. 0.3%; P = 0.61), peri-procedural infarction (4.7% vs. 6.6%; P = 0.07), stroke (0.1% vs. 0.1%; P > 0.99), PCI (0.1% vs. 0.3%; P = 0.30), coronary artery bypass graft (0 vs. 0.4%; P = 0.06), major bleeding (0.2% vs. 0.6%; P = 0.09) or vascular complications (1% vs. 0.6%; P = 0.47) was low and did not differ between groups. CONCLUSIONS: Transradial PCI has proved to be safe and effective in patients with stable and unstable CAD, treated at a tertiary hospital that has progressively incorporated this technique to its daily practice.

Comparison of Coronary Plaque Components between Non-Culprit Lesions in Patients with Acute Coronary Syndrome and Target Lesions in Patients with Stable Angina: Virtual Histology-Intravascular Ultrasound Analysis

BACKGROUND AND OBJECTIVES: The differences in plaque characteristics between non-culprit lesions (NCL) in acute coronary syndrome (ACS) patients (ACS-NCL) and target lesions (TL) in stable angina (SA) patients (SA-TL) are not well understood. We used a virtual histology-intravascular ultrasound (VH-IVUS) to compare the plaque components between ACS-NCL and SA-TL. SUBJECTS AND METHODS: We compared VH-IVUS findings between 290 ACS-NCL and 276 SA-TL. VH-IVUS classified the color-coded tissue into four major components: green (fibrotic); yellow-green (fibro-fatty); white {dense calcium (DC)}; and red {necrotic core (NC)}. Thin-cap fibroatheroma (TCFA) was defined as a NC > or =10% of the plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of > or =40% plaque burden. RESULTS: Although the plaque burden was significantly smaller (52+/-13% vs. 54+/-14%, p=0.044), ACS-NCL had a greater %NC area (17.9+/-11.6% vs. 14.3+/-8.7%, p<0.001) and %DC area (9.7+/-9.8% vs. 8.1+/-8.0%, p=0.032) compared with SA-TL at the minimum lumen site. By volumetric analysis, ACS-NCL had a greater %NC volume (15.8+/-9.2% vs. 13.9+/-7.4%, p=0.006) compared with SA-TL. TCFA was observed more frequently in ACS-NCL compared with SA-TL (27.6% vs. 18.1%, p=0.032). Independent predictors of TCFA by multivariate analysis were ACS {odds ratio (OR): 2.204, 95% CI: 1.321-3.434, p=0.021} and high-sensitivity C-reactive protein (OR: 1.101; 95% CI 1.058-1.204, p=0.035). CONCLUSION: Although the plaque burden was significantly smaller, ACL-NCL had more vulnerable plaque components compared with SA-TL, and ACS and high-sensitivity C-reactive protein were the independent predictors of TCFA.