Associated factors for the development of acute coronary syndrome or stable coronary artery disease

Abstract

Aim: The aim of this study is to clarify the associated factors for the development of acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). Methods: Five hundred thirteen de novo culprit coronary artery lesions from 513 patients (ACS, n=392, SCAD, n=121) who underwent percutaneous coronary intervention using Virtual-Histology IVUS were included. External elastic membrane cross sectional areas (EEM CSA) and lumen cross sectional areas (lumen CSA) were measured and plaque + media CSA (P+M CSA): (EEM CSA) − (lumen CSA) were calculated at the minimum lumen site, and the proximal and distal reference sites. Remodeling Index (RI); lesion EEM CSA/ {(proximal reference EEM CSA + distal reference EEM CSA)/2} was calculated. Baseline characteristics, coronary risk factors, medications and IVUS parameters were compared and multivariate logistic regression analysis was performed to identify the associated factors for the development of ACS or SCAD. Results: HDL-cholesterol level, statin, ACEI/ARB and β-blocker usage were significantly lower in ACS-group than in SCAD-group (43.5±13.1 mg/dl vs 48.1±18.1 mg/dl, p=0.002; 12.8% vs 36.4%, p<0.001; 22.7% vs 33.9%, p=0.013; 7.9% vs 14.9%, p=0.022). P+M CSA and RI were significantly larger in ACS-group than in SCAD-group (14.7±5.1 mm² vs 12.0±4.5 mm², p<0.001; 1.15±0.23 vs 1.09±0.24, p=0.012). In multivariate logistic regression analysis, HDL-cholesterol (odds ratio (OR) =0.965, p=0.002) and statin (OR=0.261, p<0.001) were negative and RI (OR=3.093, p=0.044) was positive associated factor for the development of ACS.Conclusion: Serum HDL-cholesterol level, statin usage and coronary artery remodeling were independent associated factors for the development of acute coronary syndrome or stable coronary artery disease.