Focal and multi-focal plaque macrophage distributions in patients with acute and stable presentations of coronary artery disease

J Am Coll Cardiol. 2004 Sep 1;44(5):972-9. doi: 10.1016/j.jacc.2004.05.066.


Objectives: This study was designed to utilize optical coherence tomography (OCT) images of coronary atherosclerotic plaque macrophages to investigate the relationship between macrophage distributions and clinical syndrome.

Background: The relative significance of focal macrophage infiltration and generalized coronary inflammation for predicting acute coronary events is a currently a source of considerable controversy in cardiology. Lack of a high-resolution cross-sectional imaging modality has limited macrophage evaluation in vivo.

Methods: Intracoronary OCT imaging was performed at culprit and non-culprit plaques in patients presenting with stable angina pectoris, unstable angina pectoris,and ST-segment elevation myocardial infarction. Macrophage densities were quantified from these images and analyzed with respect to the clinical presentations of the patients under investigation.

Results: A significantly greater macrophage density was found in unstable patients, both for fibrous and lipid-rich plaques (p = 0.025 and p = 0.002, respectively). Within each patient, the macrophage densities at culprit and non-culprit lesions correlated significantly (r = 0.66, y = 0.88x + 0.43, p = 0.01). Sites of plaque rupture demonstrated a greater macrophage density than non-ruptured sites (6.95 +/- 1.60%, 5.29 +/- 1.17%; p = 0.002). Surface macrophage infiltration was a stronger predictor of unstable clinical presentation than subsurface infiltration for culprit lesions (p = 0.035) but not for remote lesions (p = 0.80).

Conclusions: Our results demonstrate that increases in both multi-focal and focal macrophage densities are highly correlated with symptom severity. By providing a means of detecting increases in plaque macrophage content before an acute event, this technique may aid in determining prognosis and guiding preventive therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / physiopathology
  • Coronary Disease / pathology*
  • Coronary Disease / physiopathology
  • Coronary Vessels / pathology*
  • Female
  • Humans
  • Inflammation / pathology
  • Inflammation / physiopathology
  • Macrophages / pathology*
  • Macrophages / physiology
  • Male
  • Middle Aged
  • Myocardial Infarction / pathology*
  • Myocardial Infarction / physiopathology
  • Tomography, Optical Coherence*