Rodriguez-Granillo GA et al. (2006) Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis. Eur Heart J 27: 1921–1927

Coronary plaque rupture is known to be a major cause of sudden coronary death, but it is also commonly seen in non-coronary sudden death, and can be a clinically silent cause of plaque progression.

Rodriguez-Granillo and colleagues compared the characteristics of patients with and without plaque rupture in the coronary tree, and evaluated the plaque rupture phenotype using intravascular ultrasonography–virtual histology (IVUS-VH). Among a group of 40 patients referred for percutaneous coronary intervention, 28 plaque ruptures were diagnosed in 26 vessels of 20 patients. Sixteen (59.3%) patients with acute coronary syndrome had at least one plaque rupture (22% had multiple plaque ruptures), whereas only four (30.8%) stable patients had one or more plaque rupture. Ruptures of the left anterior descending artery, seen in 34.2% of patients, were clustered in the proximal part of the vessel, whereas those located in the right coronary artery, seen in 24.2% of patients, were more distal. The presence of plaque rupture was significantly associated with greater BMI and higher plaque burden (P = 0.01 for both). Around two-thirds of current smokers presented with plaque rupture. Compared with minimum lumen area sites, ruptured plaques showed a significantly higher content of necrotic core (P = 0.03) and a trend towards higher calcification.

In this study, therefore, patients with at least one plaque rupture in their coronary tree had higher BMI and worse IVUS-derived characteristics than patients without plaque rupture. Furthermore, the sites of plaque rupture had a worse phenotype than the sites of minimum lumen area in the same vessels.