Age-related differences in virtual histology-intravascular ultrasound findings in patients with coronary artery disease

SummaryBackgroundWe assessed the age-related differences in pre-intervention virtual histology-intravascular ultrasound (VH-IVUS) findings at target lesion sites in patients with coronary artery disease.MethodsA total of 553 patients who underwent pre-intervention VH-IVUS imaging were grouped according to age: non-elderly (≤70 years, n = 429) and elderly (>70 years, n = 124); 191 had stable angina and 362 acute coronary syndrome. VH-IVUS classified the tissue into: fibrotic, fibro-fatty, dense calcium (DC), and necrotic core (NC).ResultsOverall, the absolute and percent volumes of DC (11.0 ± 11.0 mm3 vs. 9.7 ± 11.9 mm3, P = 0.033; 11.7 ± 8.1% vs. 9.8 ± 7.2%, P = 0.014, respectively) and NC (18.5 ± 17.6 mm3 vs. 16.6 ± 18.9 mm3, P = 0.020; 18.8 ± 8.8% vs. 16.5 ± 9.3%, P = 0.026, respectively) were significantly greater in the elderly than in the non-elderly. In stable angina patients, the absolute and percent volumes of DC (10.4 ± 9.9 mm3 vs. 7.2 ± 7.6 mm3, P = 0.022; 13.4 ± 10.0% vs. 9.2 ± 6.5%, P = 0.011, respectively) and NC (14.8 ± 11.2 mm3 vs. 12.0 ± 11.9 mm3, P = 0.035; 19.6 ± 8.8% vs. 15.5 ± 8.4%, P = 0.006, respectively) were significantly greater in the elderly. However, in acute coronary syndrome patients, there were no significant differences in absolute and percent volumes of DC (11.4 ± 11.6 mm3 vs. 10.9 ± 13.4 mm3, P = 0.8; 10.7 ± 6.5% vs. 10.1 ± 7.5%, P = 0.5, respectively) and NC (24.1 ± 20.3 mm3 vs. 23.9 ± 21.2 mm3, P = 0.9; 22.0 ± 8.8% vs. 21.3 ± 9.6%, P = 0.6, respectively) between the elderly and non-elderly groups. Myocardial infarction (OR: 2.56, 95% CI: 1.45–4.12, P = 0.003), diabetes mellitus (OR: 2.23, 95% CI: 1.30–3.53, P = 0.009), and high-sensitivity C-reactive protein (OR: 1.44, 95% CI: 1.06–2.45, P = 0.042), but not age, were independent predictors of percent NC volume >20% in lesion site.ConclusionsMyocardial infarction, diabetes mellitus, and high-sensitivity C-reactive protein, but not age, were associated with NC-rich lesions. Clinical presentation, risk factors, and inflammatory status, but not age, are important factors for plaque components.