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Korean Circ J. 2011 Aug;41(8):440-446. English. Original Article.
Hong YJ , Jeong MH , Choi YH , Cho SH , Hwang SH , Ko JS , Lee MG , Park KH , Sim DS , Yoon NS , Yoon HJ , Kim KH , Park HW , Kim JH , Ahn Y , Cho JG , Park JC , Kang JC .
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.

BACKGROUND AND OBJECTIVES: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and plaque components in 279 acute coronary syndrome (ACS) patients. SUBJECTS AND METHODS: We divided patients into three groups according to their hs-CRP levels {lowest tertile <0.07 mg/dL (n=93), middle tertile > or =0.07, <0.4 mg/dL (n=93), and highest tertile > or =0.4 mg/dL (n=93)}. Thin-cap fibroatheroma (TCFA) was defined as focal, necrotic core (NC)-rich (> or =10% of the cross-sectional area) plaques in contact with the lumen in a plaque burden > or =40%. RESULTS: The highest tertile group was mostly diabetics (20%, 27%, 40%, p=0.009), and had the greatest plaque plus media volume (163+/-139/mm3 vs. 201+/-155/mm3 vs. 232+/-176/mm3, p=0.013). The highest tertile group had the greatest absolute and % NC volumes (13.6+/-15.1 mm3 vs. 14.8+/-14.2 mm3 vs. 23.7+/-24.3 mm3, p<0.001, and 14.9+/-8.7% vs. 16.0+/-8.7% vs. 19.5+/-10.2%, p=0.024, respectively). The culprit lesion TCFA was observed most frequently in the highest tertile group (28% vs. 35% vs. 55%, p=0.006). By multivariable analysis, absolute NC volume was an independent predictor of hs-CRP elevation {odds ratio (OR); 1.03, 95% confidence interval (CI)=1.06-1.21, p=0.004}, and hs-CRP was an independent predictor of TCFA (OR; 1.86, 95% CI=1.11-2.90, p=0.010). CONCLUSION: VH-IVUS analysis has demonstrated that ACS patients with elevated hs-CRP have more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFA), compared with ACS patients with normal hs-CRP.

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