Comparison of ruptured coronary plaques in patients with unstable and stable clinical presentation |
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Authors: | Cheol Whan Lee Chan-Sik Park Ilseon Hwang Hyangsin Lee Duk-Woo Park Su-Jin Kang Seung-Whan Lee Young-Hak Kim Seong-Wook Park Seung-Jung Park |
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Institution: | (1) Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea;(2) Department of Pathology, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea;(3) Department of Pathology, School of Medicine, Keimyung University, 194 Dongsan-Dong, Choong-Ku, Daegu, Korea;(4) Asan Institute of Life Science, University of Ulsan, Seoul, Korea;(5) Division of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea |
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Abstract: | It remains uncertain why some plaque ruptures trigger acute coronary syndrome (ACS), whereas others do not. We investigated
the anatomic features and tissue factor (TF) expression at the sites of plaque rupture in 42 patients presenting with ACS
(n = 23) or stable angina (n = 19). Intravascular ultrasound examination was performed before directional coronary atherectomy. Specimens were stained
with antibodies against TF, CD68 positive phagocytic cells, and smooth muscle cells; and intravascular ultrasound and immunohistochemistry
results were compared. Baseline demographic and clinical characteristics, as well as vessel and lumen sizes at both reference
and lesion sites, were comparable in the two groups. However, the remodeling index and plaque burden at lesion sites were
significantly greater in the ACS than in the stable angina group. The TF-immunopositive areas were significantly greater in
the ACS than in the stable angina group (0.07%; IQR 0.02–0.16%] vs. 0.02%; IQR 0.01–0.05%], P = 0.022), whereas the proportions of CD68-positive and smooth muscle cell areas were similar. There was a significant correlation
between areas positive for TF and those positive for CD68 (r = 0.83, P < 0.001). In conclusion, ruptured plaques in patients with ACS show stronger TF expression, a greater plaque burden, and
a higher remodeling index than do plaques in those with stable angina, suggesting that both lesion morphology and local thrombogenicity
are related to clinical symptoms after plaque rupture. |
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