Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture

Sugiyama, Tomoyo; Yamamoto, Etsuhide; Bryniarski, Krzysztof; Liu, Xing; Lee, Hang; Isobe, Mitsuaki; Libby, Peter; Jang, Ik–Kyung

doi:10.1001/jamacardio.2017.5234

Cited by 68 publications

(39 citation statements)

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“…Mean reference area was calculated from proximal and distal references, identified as sites with the largest lumen areas proximal and distal to the stenosis within the same segment 12, 13. Minimal lumen area was defined as the smallest lumen area within the length of the plaque 14. Percentage area stenosis was calculated as [(mean reference lumen area−minimal lumen area)/mean reference lumen area]×100 14.…”

Section: Methodsmentioning

confidence: 99%

“…Minimal lumen area was defined as the smallest lumen area within the length of the plaque 14. Percentage area stenosis was calculated as [(mean reference lumen area−minimal lumen area)/mean reference lumen area]×100 14. Lipid was defined as a signal‐poor region with a poorly defined or diffuse border, and the degree of lipid arc was measured in lipid plaques 12, 13.…”

Section: Methodsmentioning

confidence: 99%

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Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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BackgroundDiabetes mellitus (DM) is a major risk factor for cardiovascular events. We aimed to investigate the coronary plaque phenotype of diabetic patients who presented with acute coronary syndromes by optical coherence tomography.Methods and ResultsA total of 322 patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of the culprit lesion were included. Culprit plaque characteristics were compared between patients with DM (n=95) and those without DM (n=227). In the subgroup of 250 patients in whom sufficient length of nonculprit region in the culprit vessel was imaged by optical coherence tomography, the characteristics of nonculprit plaques were also evaluated. Patients with DM had a higher prevalence of lipid‐rich plaque (58.9% versus 44.9%, P=0.030) and macrophage accumulation (60.0% versus 44.9%, P=0.019) in the culprit lesion compared with patients without DM. The prevalence of plaque rupture (33.7% versus 30.4%, P=0.896) and plaque erosion (21.1% versus 22.0%, P=0.458) was similar. In the nonculprit lesions, the DM group had greater maximal lipid arc (248.9°±83.9° versus 179.9°±58.3°, P=0.006), thinner fibrous cap thickness (103.3±56.2 μm versus 140.7±70.0 μm, P=0.013), and a higher prevalence of thin‐cap fibroatheroma (17.2% versus 6.3%, P=0.031), compared with the non‐DM group.ConclusionsCompared with patients without DM, those with DM had more vulnerable features in both culprit and nonculprit lesions, thus indicating a higher level of panvascular instability.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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“…[ 1 – 2 ] In general, the pathological features of VP involve the following: thin fibrous cap, large lipid core, macrophage infiltration, expansive remodeling, neovascularization, and others. [ 3 – 6 ] It is noteworthy that plaques with thinner fibrous cap and larger lipid necrotic core are recognized as a distinct type of VP, termed thin cap fibroatheroma (TCFA). [ 3 – 6 ] The Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) demonstrated that TCFA was closely correlated to major adverse cardiovascular events, especially when the cap thickness was <65 μm.…”

Section: Introductionmentioning

confidence: 99%

Intensive statin versus low-dose statin + ezetimibe treatment for fibrous cap thickness of coronary vulnerable plaques

Meng

Yin

Lü

et al. 2020

Chinese Medical Journal

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Background Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT; however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography. Method Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15–20 mg or atorvastatin 30–40 mg) and combination therapy group (rosuvastatin 5–10 mg or atorvastatin 10–20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student's t test or Mann-Whitney U -test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis. Result Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs . intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = −9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = −9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up ( B = −0.203, t = −2.701, P = 0.010), ΔTC% ( B = −0.573, t = −2.048, P = 0.046), and Δhs-CRP % ( B = −0.30...

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“…Contributors to CVD have historically been understood to include the ‘traditional’ risk factors, such as family history, obesity, tobacco use, diabetes, dyslipidaemia and hypertensive disease 2. In recent years, a number of clinical trials such as Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22), and Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) have shed light on inflammatory contributions to CVD 3–5. Understanding and interest in the processes that contribute to atherosclerosis, and thus CVD, have continued to progress in conjunction with the development of novel imaging technologies that allow for earlier and finer characterisation of the atherogenic process.…”

Section: Introductionmentioning

confidence: 99%

“…Alternatively, plaque rupture can occur, resulting in infarction 2. Plaque rupture is responsible for the majority of myocardial infarction (MI), with estimates ranging from 60% to 70%, the majority of these plaques being non-calcified 3 4…”

Section: Introductionmentioning

confidence: 99%

Applying the ordinal model of atherosclerosis to imaging science: a brief review

Groenendyk

Mehta

2018

Open Heart

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Atherogenesis has been well demonstrated to proceed in an ordinal fashion. Imaging technologies have advanced substantially in recent decades, enabling early detection of atherosclerosis. Some modalities, such as coronary CT, have seen broad clinical adaptation. In contrast, others, such as flow-mediated dilatation, remain predominantly research-based. Optimal and appropriate usage of these technologies remains an area of active investigation. We hypothesise that investigators ought to consider which stage of atherosclerosis is under investigation when choosing imaging modalities. Additionally, when assessing the efficacy of a particular treatment, some imaging modalities may be more appropriate than others. We review the most important available imaging modalities and suggest stages at which each may or may not be well used. Conceptual application of the classic stages of atherosclerosis model to the variety of modern imaging modalities available will result in more effective investigation and treatment of cardiovascular disease.

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Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture

Cited by 68 publications

References 50 publications

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Intensive statin versus low-dose statin + ezetimibe treatment for fibrous cap thickness of coronary vulnerable plaques

Applying the ordinal model of atherosclerosis to imaging science: a brief review

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