Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: A 3-vessel optical coherence tomography study - 10/12/13

Doi : 10.1016/j.ahj.2013.10.011

Rocco Vergallo, MD ^a, Xuefeng Ren, MD ^b, Taishi Yonetsu, MD ^a, Koji Kato, MD, PhD ^a, Shiro Uemura, MD, PhD ^c, Bo Yu, MD, PhD ^b, Haibo Jia, MD, PhD ^a,^b, Farhad Abtahian, MD, PhD ^a, Aaron D. Aguirre, MD, PhD ^d, Jinwei Tian, MD, PhD ^a,^b, Sining Hu, MD ^a,^b, Tsunenari Soeda, MD, PhD ^a, Hang Lee, PhD ^e, Iris McNulty, RN ^a, Seung-Jung Park, MD, PhD ^f, Yangsoo Jang, MD, PhD ^g, Abhiram Prasad, MD ^h, Stephen Lee, MD ⁱ, Shaosong Zhang, MD, PhD ^j, Italo Porto, MD, PhD ^k, Luigi M. Biasucci, MD, PhD ^l, Filippo Crea, MD ^l, Ik-Kyung Jang, MD, PhD ^a,^{^⁎}
^a Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^b Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
^c First Department of Medicine, Nara Medical University, Nara, Japan
^d Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
^e Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
^f Asan Medical Center, Seoul, Republic of Korea
^g Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
^h Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
ⁱ Department of Medicine, Queen Mary Hospital, Hong Kong University, Hong Kong, China
^j LightLab Imaging, Inc/St Jude Medical, Westford, MA
^k Cardiovascular and Neurological Department, San Donato Hospital, Arezzo Italy
^l Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy

^⁎Reprint requests: Ik-Kyung Jang, MD, PhD, Cardiology Division, Massachusetts General Hospital, 55 Fruit St, GRB 800, Boston, MA 02114.

Résumé

Background

Recent studies described different clinical and underlying plaque characteristics between patients with and without plaque rupture presenting with acute coronary syndrome (ACS). In light of the systemic nature of atherosclerosis, we hypothesized that nonculprit plaques might also express different morphological features in these 2 groups of patients.

Methods

Thirty-eight patients with ACS who underwent 3-vessel optical coherence tomography imaging were identified from the Massachusetts General Hospital Optical Coherence Tomography Registry. Based on culprit plaque morphology, the study population was divided into 2 groups: patients with plaque rupture at the culprit lesion (group 1) and patients with nonruptured plaque at the culprit lesion (group 2). Prevalence and features of nonculprit plaques were compared between the 2 groups.

Results

A total of 118 nonculprit plaques were analyzed. Patients in group 1 (n = 17) had nonculprit plaques with higher prevalence of thin-cap fibroatheroma (52.9% vs 19.0%, P = .029) and disruption (35.3% vs 4.8%, P = .016) compared with patients in group 2 (n = 21). Nonculprit plaques in group 1 showed wider maximum lipid arc (198.9° ± 41.7° vs 170.2° ± 41.9°, P = .003), greater lipid length (7.8 ± 4.4 mm vs 5.1 ± 2.4 mm, P = .003), higher lipid index (1196.9 ± 700.5 vs 747.7 ± 377.3, P = .001), and thinner fibrous cap (107.0 ± 56.5 μm vs 137.3 ± 69.8 μm, P = .035) compared with those in group 2.

Conclusions

The present study showed distinctive features of nonculprit plaques between patients with ACS caused by plaque rupture and patients with ACS caused by nonruptured plaques. Patients with plaque rupture had increased pancoronary vulnerability in nonculprit plaques, suggesting that a more aggressive treatment paradigm aiming at the stabilization of vulnerable plaques may offer additional benefit to these patients.

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Plan

Methods

Study population

Optical coherence tomography image acquisition

Optical coherence tomography image analysis

Quantitative coronary angiographic analysis

Statistical analysis

Source of funding

Results

Optical coherence tomography findings

Intraobserver and interobserver agreements

Discussion

Different nonculprit plaque profile between patients with ACS caused by plaque rupture and patients with ACS caused by nonruptured plaques

Pancoronary plaque instability in patients with ACS caused by plaque rupture

Clinical implications

Study limitations

Conclusions

Disclosures

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Vol 167 - N° 1

P. 59-67 - janvier 2014 Retour au numéro

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Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: A 3-vessel optical coherence tomography study - 10/12/13

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