Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta‐analysis

Abstract Background There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta‐analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non‐culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non‐culprit lesions in acute coronary syndromes patients. Methods A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random‐effects models. Results Twenty‐eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin‐Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non‐culprit lesions. Non‐culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin‐Cap Fibroatheromas than in stable angina. Conclusion Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non‐culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.