Plaque Vulnerability Phenotype in Patients with Coronary Artery Disease An Intravascular Ultrasound Radiofrequency Analysis

The relationship between plaque morphology and clinical presentation was examined. Lumen dimensions, atheroma morphology and composition were assessed by virtual histology intravascular ultrasound (VH-IVUS) in 1757 frames of coronary segments of interest of 17 patients with acute and chronic coronary artery disease, i. e., ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction, unstable angina (UA) and stable angina (SA). Large plaque areas with distended elastic lamina (EEL), rich in fibrotic (FB) and fibro-fatty (FF) tissues associated with STEMI and UA. Variants of this phenotype consisting of large calcium deposits and reduced lumen area were prevalent in NSTEMI patients. SA patients consistently showed plaques with small areas, marked constrictive growth and low FF content. IVUS-derived plaque measures provided phenotypes of vulnerability and rupture that may help improving risk stratification of both symptomatic and asymptomatic patients.