More Fallout From Plaque Ruptures In Store For Heart Attack Survivors

About 80 percent of patients recovering from a first heart attack have unstable plaque some distance from the blockages, indicating vulnerability to more heart problems, the study finds.

Researchers believe this is the first study to use high-resolution pictures available with intravascular ultrasound (IVUS) to get three-dimensional (3-D) pictures of the inside the three major coronary arteries during the month following a major event.

After an acute coronary syndrome event such as a heart attack or severe chest pain, there is a high risk of another episode within the year. Previous research has documented a surge in the plaque buildup in the inner lining of arteries (atherosclerosis) after such an event.

This study confirms the notion of overall coronary instability known as "pancoronaritis." "We were very surprised to find that almost four out of five patients present one or more ruptured atherosclerotic plaques besides the culprit lesion," says lead author Gilles Rioufol, M.D., Ph.D, an associate professor in the hemodynamics department of the Cardiologic Hospital, Hospices Civils de Lyon, Lyon, France. "We were even more surprised to see that these distinct ruptured plaques involved all three main coronary trunks.

In fact, for one in eight patients all three main arteries were affected."

These findings also support the hypothesis that inflammation plays a role in heart disease events, says Rioufol.

Atherosclerosis is a progressive condition that develops over many years. Stable plaque that remains in place tends not to cause a heart attack. When the plaque becomes unstable and ruptures, the body responds to that injury with inflammation, which includes forming blood clots to repair the injury. These clots block the artery and cause a heart attack. Plaque rupture or erosion is a prime cause of heart attack and might itself be triggered by inflammation.