Thin-cap fibroatheroma association with local inflammatory activity in coronary disease: an optical-coherence tomography study.

OBJECTIVE: The aim of the present study is to assess whether the intensity of local inflammation relates to the presence of thin-cap fibroatheromas. METHODS: Retrospective, single-center study of patients that underwent optical coherence tomography imaging and had either de novo or in-stent neoatherosclerosis. Intensity of macrophage accumulation and volume of neovascularization were measured for all lesions. Logistic binary regressions were used for uni- and multivariate analysis. RESULTS: A total of the 92 lesions in 84 patients were selected. The degree of macrophage accumulation was higher in thin-cap fibroatheromas than non- thin-cap fibroatheromas lesions (5.0 versus 2.17; p<0.01). Neovascularization was more frequent in thin-cap fibroatheromas than non-thin-cap fibroatheromas lesions (87.5% versus 65.7%, p=0.04), and thin-cap fibroatheromas had a larger volume of neovascularization than non- thin-cap fibroatheromas plaques (92.2 versus 23.0 x 1000μm3/mm, p<0.01). At multivariate logistic analysis, neovascularization volume and degree of macrophage accumulation remained independently associated with thin-cap fibroatheromas. The dataset was divided according to the highest tercile of neovascularization volume (≥87.2 x 1000μm3/mm) and macrophage accumulation score (≥4.6). Plaques with low levels of neovascularization and macrophages were classified as thin-cap fibroatheromas in 14% of cases. Thin-cap fibroatheromas was present in 61.5% of plaques with high macrophagic and neovascularization content. CONCLUSION: Lesions with more macrophage accumulation and higher volumes of neovascularization are more likely to be thin-cap fibroatheromas.