Characteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque

Abstract

Aims Layered plaques represent signs of previous plaque destabilization. A recent study showed that acute coronary syndrome (ACS) patients with layered culprit plaque have more vulnerability at the culprit lesion and systemic inflammation. We aimed to compare the characteristics of non-culprit plaques between patients with or without layered plaque at the culprit lesion. We also evaluated the characteristics of layered non-culprit plaques, irrespective of culprit plaque phenotype. Methods and results We studied ACS patients who had undergone pre-intervention optical coherence tomography (OCT) imaging. The number of non-culprit lesions was evaluated on coronary angiogram and morphological characteristics of plaques were studied by OCT. In 349 patients, 99 (28.4%) had layered culprit plaque. The number of non-culprit plaques in patients with or without layered culprit plaque was similar (3.2 ± 0.8 and 2.8 ± 0.8, P = 0.23). Among 465 non-culprit plaques, 145 from patients with layered culprit plaque showed a higher prevalence of macrophage infiltration (71.0% vs. 60.9%, P = 0.050). When analysed irrespective of culprit plaque phenotype, layered non-culprit plaques showed higher prevalence of lipid (93.3% vs. 86.0%, P = 0.028), thin cap fibroatheroma (29.7% vs. 13.7%, P < 0.001), and macrophage infiltration (82.4% vs. 54.0%, P < 0.001) than non-layered plaques. Plaques with layered phenotype at both culprit and non-culprit lesions had the highest vulnerability. Conclusion In ACS patients, those with layered phenotype at the culprit lesion demonstrated greater macrophage infiltration at the non-culprit sites. Layered plaque at the non-culprit lesions was associated with more features of plaque vulnerability, particularly when the culprit lesion also had a layered pattern.

Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography

“…1. line with the current study [6]. Furthermore, in the current study, a TCFA adjacent to an HP was more frequently observed in an NCL containing an HP associated with subsequent events versus an NCL containing an HP that was not associated with an event.…”

“…NCLs were considered separate if there was a ≥5 mm-long normal segment between them. HP was defined as a heterogeneous signal-rich layer of different optical intensity located close to the luminal surface with clear demarcation from the underlying plaque [5,6,14] (Fig. 1A).…”

“…An ex vivo study demonstrated that healed plaque (HP) detected by optical coherence tomography (OCT) showed high positive and negative predictive values (both 93%) versus histology [5]. In addition, an in vivo OCT study revealed that HP in non-culprit plaques in acute coronary syndrome (ACS) patients was associated with vulnerable plaque morphology [6]; however, clinical data focusing on HP in untreated (non-culprit) segments including stable patients and their impact on subsequent clinical outcomes remains unknown. In addition, although several previous intravascular ultrasound (IVUS) studies defined nonculprit lesions (NCLs) as lesions having plaque burden ≥40% [7][8][9], there is a lack of OCT criteria to detect NCLs.…”

Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome

“…The authors therefore concluded that the associations with plaque vulnerability may outweigh the protective mechanism of plaque healing and might actually predispose patients to future acute coronary events. In a following study of the same cohort of ACS patients, it was shown that this association with vulnerable plaque characteristics also extended to healed non-culprit lesions [34].…”

Management of Culprit and Non-Culprit Lesions in Acute Coronary Syndrome

“…Additionally, with a more severe degree of stenosis, there was a higher incidence of adverse plaque characteristics (APC) and worse hemodynamic parameters. [13][14][15] The identification of culprit lesions with the use of advanced imaging techniques, such as CCTA and FFR, could be useful in the risk stratification of patients and in the prediction of major cardiac events. 16 Furthermore, CT-FFR, developed by Taylor et al, offers an approximated value of fractional flow reserve from standard coronary computed tomography images using advanced computational modeling of fluid dynamics.…”