Prospective comparison of coronary artery remodeling between acute coronary syndrome and stable angina in single-vessel disease: Correlation between C-reactive protein and extent of arterial remodeling

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Abstract
Background: Retrospective intravascular ultrasound (IVUS) studies showed that positive remodeling of coronary artery was associated with unstable clinical presentation. However, no prospective IVUS study has been performed to demonstrate such relationship. The relationship between C‐reactive protein (CRP) and coronary artery remodeling is unknown. Hypothesis: Positive remodeling might be related with acute coronary syndrome in the prospective IVUS study. C‐reactive protein levels might be associated with coronary artery remodeling. Methods: Preintervention IVUS images were prospectively obtained in 93 patients with single‐vessel disease (30 for acute coronary syndrome and 63 for stable angina). Serum sample for CRP measurement was collected 24 h prior to coronary intervention. The remodeling index was defined as a ratio of (lesion/average reference) external elastic membrane area. Positive remodeling was defined as a remodeling index > 1.05 and negative remodeling as a remodeling index < 0.95. Results: The remodeling index was 0.99 ± 0.13 in acute coronary syndrome versus 0.95 ± 0.12 in stable angina (p = 0.048). Positive remodeling was associated with acute coronary syndrome (43 vs. 19%), whereas negative remodeling was more frequent in stable angina (49 vs. 33%) (p = 0.047). C‐reactive protein levels were significantly higher in acute coronary syndrome than in stable angina (1.4 ± 2.0 vs. 0.5 ± 0.6 mg/dl, respectively, p = 0.002). However, there was no significant correlation between CRP levels and remodeling index (r = 0.078, p = 0.475). Conclusions: Positive remodeling may be related with acute coronary syndrome in the prospective IVUS analysis. C‐reactive protein levels may not predict the extent of arterial remodeling.