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American Heart Journal

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Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study - 11/08/23

Doi : 10.1016/j.ahj.2023.06.006 
Ziqian Weng, MD a, b, c, #, Chen Zhao, MD a, b, c, #, Yuhan Qin, MD a, b, c, #, Cong Liu, MD d, Weili Pan, MD a, b, c, Sining Hu, MD a, b, c, Luping He, MD a, b, c, Yishuo Xu, MD a, b, c, Ming Zeng, MD a, b, c, Xue Feng, MD a, b, c, Rui Gao, MD a, b, c, Xianghao Yu, MD a, b, c, Minghao Liu, MD a, b, c, Boling Yi, MD a, b, c, Dirui Zhang, MD a, b, c, Ekaterina Koniaeva, MD a, b, c, Timur Musin, MD a, b, c, Diler Mohammad, MD a, b, c, Bin Zhu, MD a, b, c, Yanli Sun, MD a, b, c, Jingbo Hou, MD, PhD a, b, c, Jiawei Tian, MD, PhD d, Gary S. Mintz, MD e, Haibo Jia, MD, PhD a, b, c, Bo Yu, MD, PhD a, b, c, ⁎
a Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China 
b National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China 
c The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China 
d Department of Ultrasound, The second Affiliated Hospital of Harbin Medical University, Harbin, China 
e Cardiovascular Research Foundation, New York, 10019 NY, USA 

⁎Reprint requests: Bo Yu, MD, PhD, FACC, Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin 150086, China.Department of CardiologyThe second Affiliated Hospital of Harbin Medical UniversityNational Key Laboratory of Frigid Zone Cardiovascular Diseasesand The Key Laboratory of Myocardial IschemiaChinese Ministry of Education246 Xuefu RoadNangang DistrictHarbin 150086China

Riassunto

Background

Plaque rupture (PR) and plaque erosion (PE) are 2 distinct, different, and most common culprit lesion morphologies responsible for acute coronary syndrome (ACS). However, the prevalence, distribution, and characteristics of peripheral atherosclerosis in ACS patients with PR vs PE has never been studied. The aim of this study was to assess peripheral atherosclerosis burden and vulnerability evaluated by vascular ultrasound in ACS patients with coronary PR vs PE identified by optical coherence tomography (OCT).

Methods

Between October 2018 and December 2019, 297 ACS patients who underwent preintervention OCT examination of the culprit coronary artery were enrolled. Peripheral ultrasound examinations of carotid, femoral, and popliteal arteries were performed before discharge.

Results

Overall, 265 of 297 (89.2%) patients had at least one atherosclerotic plaque in a peripheral arterial bed. Compared with coronary PE, patients with coronary PR had a higher prevalence of peripheral atherosclerotic plaques (93.4% vs 79.1%, P < .001), regardless of location: carotid, femoral, or popliteal arteries. The number of peripheral plaques per patient was significantly larger in the coronary PR group than coronary PE (4 [2-7] vs 2 [1-5], P < .001). Additionally, there was a greater prevalence of peripheral vulnerable characteristics including plaque surface irregularity, heterogeneous plaque, and calcification in patients with coronary PR vs PE.

Conclusions

Peripheral atherosclerosis exists commonly in patients presenting with ACS. Patients with coronary PR had greater peripheral atherosclerosis burden and more peripheral vulnerability compared to those with coronary PE, suggesting that comprehensive evaluation of peripheral atherosclerosis and multidisciplinary cooperative management maybe necessary, especially in patients with PR.

Trial registration

clinicaltrials.gov (NCT03971864)

Il testo completo di questo articolo è disponibile in PDF.

Graphical abstract




 : 

Greater peripheral atherosclerosis burden has been demonstrated in patients with coronary PR, shown as significantly higher prevalence of peripheral plaques (93.4% vs 79.1%, P ＜ .001), more sites of vascular beds affected by atherosclerosis, and a larger number of plaques per patient. Patients with coronary PR had more peripheral vulnerability including calcification (64.9% vs. 45.3%, P = .002), heterogeneous plaque (77.3% vs 54.7%, P ＜ .001), and surface irregularity (60.2% vs. 37.2%, P ＜ .001), independent of conventional coronary risk factor profile. ACS = acute coronary syndrome; PE = plaque erosion; PR = plaque rupture.


Greater peripheral atherosclerosis burden has been demonstrated in patients with coronary PR, shown as significantly higher prevalence of peripheral plaques (93.4% vs 79.1%, P ＜ .001), more sites of vascular beds affected by atherosclerosis, and a larger number of plaques per patient. Patients with coronary PR had more peripheral vulnerability including calcification (64.9% vs. 45.3%, P = .002), heterogeneous plaque (77.3% vs 54.7%, P ＜ .001), and surface irregularity (60.2% vs. 37.2%, P ＜ .001), independent of conventional coronary risk factor profile. ACS = acute coronary syndrome; PE = plaque erosion; PR = plaque rupture.Image, graphical abstract

Il testo completo di questo articolo è disponibile in PDF.

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