Ruptured versus stable plaques in human coronary arteries

Coron Artery Dis. 2011 Aug;22(5):345-51. doi: 10.1097/MCA.0b013e3283471f95.


Objective: To derive a model for the identification of left anterior descending (LAD) coronary artery stenoses predisposed to plaque rupture and thrombosis.

Methods: Coronary angiograms of 186 consecutive patients (original sample) with an anterior ST elevation myocardial infarction (STEMI) and a recanalized LAD were reconstructed in the three-dimensional space. Culprit lesions were compared with 293 stable LAD coronary stenoses on the same patients. A model for predicting stenoses with a high probability of thrombosis was derived and validated in 50 subsequent patients with STEMI, and 50 patients with stable lesions (validation sample).

Results: The majority of culprit lesions occurred between 20 and 40 mm from the LAD ostium, whereas the majority of stable lesions were found in a distance of more than 60 mm (P<0.001). Culprit lesions were statistically significantly longer than stable ones (23.2 ± 10.4 mm vs. 14.7 ± 7.2 mm; P<0.001). Bifurcations on culprit lesions were significantly more frequent (86.6%) compared with stable lesions (41.3%, P<0.001). Lesion angulation was significantly sharper in culprit lesions, which were symmetrical whereas stable lesions resided in the inner vessel wall in respect to the local vessel curvature. A simple additive tool was developed by using these parameters in a multiple regression model. The discriminating ability of the proposed index was high in both the original [area under the receiver operating characteristic curve: 0.88 (95% confidence interval: 0.85-0.91)] and validation sample [area under the receiver operating characteristic curve: 0.69 (95% confidence interval: 0.59-0.78)].

Conclusion: Specific anatomic characteristics of LAD segments associated with STEMI can be identified on coronary angiograms and assist the risk stratification of coronary stenoses.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Angiography
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / pathology
  • Coronary Thrombosis / complications
  • Coronary Thrombosis / pathology*
  • Coronary Vessels / pathology*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / pathology*
  • Plaque, Atherosclerotic / complications
  • Plaque, Atherosclerotic / pathology*
  • Rupture, Spontaneous / complications
  • Rupture, Spontaneous / pathology