| The purpose of this study was to assess the " Culprit lesion" morphology of Acute Coronary Syndrome by Intravascular Ultrasound (IVUS) in vivo.Methods1. Patients: As the subjects of study, 57 lesions of 57 patients with CAD (17with AMI, 23 with UAP and 17 with SAP. ) were enrolled prospectively at Beijing Red Cross Chaoyang Hospital from August 2002 to November 2003. Of these 57 lesions, 42(73.7% ) were located in the left anterior descending arter-y, 4(7.0% ) in the circumflex artery and 11 (19.3% ) in the right coronary artery.2. Intravascular Ultrasound device; The IVUS catheter (Boston Scientific Co. Watertown, Mass, U. S. A. ) used a single-element (30MHz) at its tip. The system is based on a mechanically motor-driven rotating catheter tip element connected to a flexible drive shaft. The other one ( Endosonics Co, Ltd , California, U. S. A. ) was 3.2F real-time with a 64-crystal (30MHz) at its tip.3. Procedure; After coronary angiography and before PTC A. The IVUS catheter was introduced into target vessel distally as far as possible over a 0.14-inch guide wire, and cross-section images of the coronary artery were obtained by slowly pull back the catheter at a speed of l-2mm/s. The position of theIVUS probe was documented on X-ray film.4. IVUS image analysis: All the IVUS images were reviewed off-line. A coronary system with a regular lumen and without intimal thickening was considered normal. A segment showing concentric or eccentric atherosclerotic plaque was considered diseased. Qualitative and quantitative analysis were according to Ge and American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of IVUS.5. Statistical analysis: Statistical analysis was performed using SPSS 11.5. Results were expressed as mean ?SD for continuous variables. Qualitative data were presented as number (% ). Continuous variables were compared using Students t test and categorical variables with chi-square test or Fisher exact test. A P value <0.05 was required for statistical significance.Results1. There were no significant differences in demographic data and clinical characteristic between the two groups: patients with ACS and SAP, even among the three groups.- patients with AMI, UAP, and SAP. A P value >0.05.2. There were no significant differences in IVUS parameter among the three groups: patients with AMI, UAP, and SAP. A P value >0.05.3. There were significant differences in Qualitative data; (1) Thirty-two of 40 patients(80% ) with ACS but only 3 of 17 patients(17. 6% ) with SAP had soft plaque. P <0. 05. (2) Twenty-three of 40 patients (57. 5% ) with ACS but no of patients with SAP had dissection or tear in the fibrous cap. P <0.05. (3) Thirty-two of 40 patients(80% ) with ACS but only 9 of 17 patients (52. 9%) with SAP had eccentric plaque. P < 0. 05. (4) We identified thrombus over the plaque in 17 of 40 patients (42.5% ) with ACS but no in patients with SAP, P<0.05. (5)Positive remodeling occur in the coronary artery in 21 of 40 patients (52.5% ) with ACS, but negative in 10 of 17 patients (58. 9% ) with SAP, P <0.05. (6) We detected lipid-pool in 21 of 40(52.5% ) patients with ACS but 4 of 17(23.5%) patients with SAP, P<0.05.4. There were no significant differences in Qualitative data between patientswith AMI and patients with UAP. P >0.05. 5. The fibrous cap in patients with ACS was thinner than in patients with SAP ( 0. 41 ±0. 23mm VS 0.. 82 ± 0. 34mm, P <0. 05). The lipid-pool area in patients with ACS was bigger than in patients with SAP (3.23 ± 1.45mm2 VS 1.68 ±0.47mm2, P<0.05).6. There were no differences in the thickness of fibrous cap between patients with AMI and UAP (0. 42 ± 0. 13mm VS 0. 40 ± 0. 30mm, P > 0. 05). However, the lipid-pool area in patients with AMI is bigger than that in patients with UAP (3.95 ±1.73 mm2 vs 2.58 ±0.73 mm2, P<0.05).Conclusions1. The plaques in patients with ACS are often vulnerable which means big lipid-pool, even bi...
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