Evolution of spontaneous atherosclerotic plaque rupture with medical therapy -: Long-term follow-up with intravascular ultrasound

Background - Ruptured coronary atheromatous plaque is generally considered to involve a high risk of subsequent clinical events. Few data are available on the natural evolution of non-culprit-lesion ruptured plaque. We therefore used serial intravascular ultrasound (IVUS) to study how such lesions, detected in the context of a first acute coronary syndrome with elevated troponin I levels, develop. Methods and Results - Fourteen patients with 28 distinct plaque ruptures ( 2 +/- 1 per patient) without significant associated stenosis ( minimal lumen cross-sectional area > 4 mm(2)) were included and systematically treated with 40 mg statin and antiplatelet agent ( clopidogrel and aspirin for greater than or equal to 9 months). Mean clinical and IVUS follow-up was 22 +/- 13 months ( median, 22 months). No clinical event related to the lesion under study occurred. On final IVUS examination, half ( 14 of 28) of the ruptured plaques had healed, and the degree of stenosis tended to diminish ( stenosis, 22 +/- 17% versus 29 +/- 17% at baseline; P = 0.056). No healing-prediction criterion could be identified. Conclusions - Nearly 2 years of follow-up found that spontaneous coronary atheromatous plaque rupture without significant stenosis detected on first acute coronary syndrome healed without significant plaque modification in 50% of cases with medical therapy.