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Background— We evaluated the incidence and predictors of single and multiple plaque ruptures in acute myocardial infarction (AMI) and stable angina pectoris (SAP).

Methods and Results— We performed 3-vessel intravascular ultrasound (IVUS) examination in 235 patients: 122 had AMI, and 113 had SAP. Plaque rupture of infarct-related or target lesions occurred in 80 AMI patients (66%) and in 31 SAP patients (27%) (P<0.001). Non–infarct-related or non–target artery plaque ruptures occurred in 21 AMI patients (17%) and 6 SAP patients (5%) (P=0.008). Multiple plaque ruptures were observed in 24 AMI (20%) and 7 SAP patients (6%) (P=0.004). Therefore, at least 1 plaque rupture in any coronary artery was noted in 84 AMI patients (69%) and 35 SAP patients (31%) (P<0.001). Overall, the only independent clinical predictor of plaque rupture in the infarct-related/target lesion was AMI (P<0.01; OR, 4.867; 95 …