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

We 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.

A total of 553 patients who underwent pre-intervention VH-IVUS imaging were grouped according to age: non-elderly (< or = 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).

Overall, the absolute and percent volumes of DC (11.0 + or - 11.0mm(3) vs. 9.7 + or - 11.9 mm(3), P=0.033; 11.7 + or - 8.1% vs. 9.8 + or - 7.2%, P=0.014, respectively) and NC (18.5 + or - 17.6mm(3) vs. 16.6 + or - 18.9 mm(3), P=0.020; 18.8 + or - 8.8% vs. 16.5 + or - 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 + or - 9.9 mm(3) vs. 7.2 + or - 7.6 mm(3), P=0.022; 13.4 + or - 10.0% vs. 9.2 + or - 6.5%, P=0.011, respectively) and NC (14.8 + or - 11.2 mm(3) vs. 12.0 + or - 11.9 mm(3), P=0.035; 19.6 + or - 8.8% vs. 15.5 + or - 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 + or - 11.6 mm(3) vs. 10.9 + or - 13.4 mm(3), P=0.8; 10.7 + or - 6.5% vs. 10.1 + or - 7.5%, P=0.5, respectively) and NC (24.1 + or - 20.3 mm(3) vs. 23.9 + or - 21.2 mm(3), P=0.9; 22.0 + or - 8.8% vs. 21.3 + or - 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.

Myocardial 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.