Pancoronary Plaque Characteristics in STEMI Caused by Culprit Plaque Erosion Versus Rupture

Cao, Mingming; Zhao, Lianbi; Ren, Xia; Wu, Tianyu; Yang, Guang; Du, Zhuo; Hou, Yu; Dai, Jihong; Li, Lulu; Wang, Yini; Guo, Wei; Ma, Lei; Liu, Xing; Tu, Yingfeng; Fang, Shaohong; Tian, Jing; Jia, Haibo; Mintz, Gary S.; Yu, Bo

doi:10.1016/j.jcmg.2020.07.047

Cited by 29 publications

(26 citation statements)

References 27 publications

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“…Abundant and homogeneous macrophage accumulation in coronary arterial wall was also found in ACS patients with DM [ 26 ]. Another study investigated non-culprit plaque in STEMI patients, and found that STEMI patients with culprit plaque erosion have a limited pancoronary vulnerability than STEMI patients with plaque rupture, which may also explain the better outcomes in patients with erosion than rupture [ 27 ]. Patients with plaque erosion had fewer other coronary risk factors (dyslipidemia, hypertension, chronic kidney disease, and DM) than those with plaque rupture [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study

Deng

Lei

et al. 2021

Cardiovasc Diabetol

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Background Apolipoprotein (Apo) A1 and Apo B are strongly associated with the risk of atherosclerotic cardiovascular disease (ASCVD). However, the relationship between the Apo B/A1 ratio and the morphology of coronary vulnerable plaques has not been fully elucidated in patients with ASCVD. Methods A total of 320 patients with ASCVD undergoing percutaneous coronary intervention were enrolled and assigned into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) group. The morphology of culprit plaque was analyzed by intravascular optical coherence tomography. Association between the Apo B/A1 ratio and coronary vulnerable plaques were evaluated using logistic regression models and receiver operator characteristic (ROC) curve analyses. Results The Apo B/A1 ratio was higher in ACS patients than CCS patients (0.77 ± 0.28 vs. 0.64 ± 0.22, P < 0.001) and it was also higher in patients with plaque rupture, erosion or thrombus than those without culprit plaques. The high Apo B/A1 ratio was associated with high percent of vulnerable plaques compared with low ratio group. The Apo B/A1 ratio was negatively related to fibrous cap thickness in lipid-rich plaque (r = − 0.228, P = 0.043). Univariate and multivariate logistic regression analyses revealed that the Apo B/A1 ratio was an independent factor of plaque rupture, erosion, and thrombus. The area under the ROC curve of the Apo B/A1 ratio for plaque rupture, erosion, and thrombus were 0.632, 0.624, and 0.670 respectively (P < 0.001 for all), which were higher than that of low-density lipoprotein cholesterol. Conclusions The Apo B/A1 ratio is an independent predictor for plaque rupture, erosion, and thrombus in patients with ASCVD.

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Section: Discussionmentioning

confidence: 99%

Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study

Deng

Lei

et al. 2021

Cardiovasc Diabetol

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“…OCT imaging was acquired with a commercially available C7-XR or ILUMIEN OPTIS or OPTIS Integrated System (Abbott Vascular, Santa Clara, CA, USA) ( 2 , 10 , 11 ). As noted above, pre-intervention OCT of the culprit lesion was performed before and OCT imaging of non-culprits was performed after treatment of the infarct lesion.…”

Section: Methodsmentioning

confidence: 99%

“…and T.W.) who were blinded to clinical, angiographic, and laboratory data using an offline review workstation (Abbott Vascular) ( 2 , 10 , 11 ). Any discordance was resolved by consensus with a third reviewer (Z.D.).…”

Section: Methodsmentioning

confidence: 99%

“…Plaque erosion (PE) is a distinct pathological and clinical entity and the second most common cause of coronary thrombosis; it is responsible for 25–35% of acute coronary syndrome (ACS) and may have its own tailored management strategy ( 1 ). Furthermore, patients with culprit eroded plaques have a lower prevalence of rupture-related pancoronary, non-culprit lesion instability to include a lower prevalence of thin-cap fibroatheromas (TCFA), plaque ruptures, and high-risk plaques as defined in the CLIMA study (NCT02883088), regardless of systemic risk factor profiles ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

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Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study

Cao

Zhao

et al. 2021

Front. Cardiovasc. Med.

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Objective: This study compared focal geometry and characteristics of culprit plaque erosion (PE) vs. non-culprit plaques in ST-segment elevated myocardial infarction (STEMI) patients in whom optical coherence tomography (OCT) identified PE as the cause of the acute event.Background: Culprit PE is a distinct clinical entity with specific coronary risk factors and its own tailored management strategy. However, not all plaques develop erosion resulting in occlusive thrombus formation.Methods: Between January 2017 and July 2019, there were 484 STEMI patients in whom OCT at the time of primary percutaneous intervention identified culprit lesion PE to be the cause of the event; 484 culprit PE were compared to 1,132 non-culprit plaques within 1,196 imaged vessels.Results: Culprit PE were highly populated at “hot spots” within the proximal 40 mm in the left anterior descending artery (LAD) and tended to cluster proximal to a nearby bifurcation mainly in the LAD. Minimal lumen area (MLA) <2.51 mm2 and AS (area stenosis) >64.02% discriminated culprit PE from non-culprit plaques. In the multivariable analysis, focal geometry (LAD location, distance from coronary ostium <40 mm, and location proximal to a nearby bifurcation), luminal narrowing (MLA <2.51 mm2, AS > 64.02%), and TCFA phenotype were independent predictors of culprit PE overall. Cholesterol crystals were predictive of culprit PE with underlying LRP morphology while the absence of calcification and microchannels were risk factors for culprit PE with an underlying non-LRP. Similarities and differences in predictors of culprit PE were found between males and females; distance from coronary ostium <40 mm, MLA <2.51 mm2, TCFA, and less spotty calcium were risk factors of culprit PE in males, but not in females while smaller RVD was associated with culprit PE only in females.Conclusions: Irrespective of underlying lesion substrates and patient risk factors, there are lesion-specific and OCT-identifiable predictors of developing culprit PE in erosion-prone vulnerable patients.

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“…Based on the CLIMA study, 9 a high-risk plaque was defined as a nonculprit plaque with the simultaneous presence of an MLA of <3.5 mm 2 , an FCT of <75 μm, a maximum lipid arc of >180 , and macrophages in the same plaque. Qualitative and quantitative analyses of all lesions were performed as previously described 12,14 and are described in more detail in the Supplemental Methods (Appendix S1).…”

Section: Oct Image Acquisition and Analysismentioning

confidence: 99%

Association of the age shock index with coronary plaque characteristics in ST‐segment elevation myocardial infarction: A 3‐vessel optical coherence tomography study

Zhao

et al. 2021

Cathet Cardio Intervent

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Objectives: We investigated whether the age shock index (SI) was associated with coronary plaque characteristics in patients with ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT). Background:The age SI is a simple clinical parameter that effectively predicts poor clinical outcomes among patients with STEMI. Methods: This retrospective study evaluated 408 STEMI patients who underwent 3-vessel OCT during emergency percutaneous coronary interventions at a single center between January 2017 and October 2018. Patients were divided into groups with low or high age SI values (<41 vs. ≥41). Plaque characteristics were compared between the two groups for both culprit lesions (n = 408) and non-culprit lesions (n = 1,077).Results: In culprit lesions, patients with a high age SI (≥41) were more likely to have plaque rupture (61.0% vs. 56.8%, p = .002) and thinner fibrous caps (fibrous cap thickness [FCT]: 40.0 [33.0-53.0] μm vs. 46.0 [36.0-63.8] μm, p = .021). In nonculprit lesions, patients with a high age SI were more likely to have high-risk plaques (29.9% vs. 17.8%, p = .018; simultaneous presence of a minimal lumen area of <3.5 mm 2 , maximum lipid arc of >180 , FCT of <75 μm, and macrophage accumulation). Plaque-based analyses revealed that patients with a high age SI had larger lipid cores and lesser FCT.Conclusions: Patients with STEMI and a high age SI had increased risks of culprit plaque rupture and high-risk non-culprit plaques, and vulnerable plaque features at the culprit and non-culprit lesions. Therefore, a high age SI in patients with STEMI may indicate greater pancoronary vulnerability.

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Pancoronary Plaque Characteristics in STEMI Caused by Culprit Plaque Erosion Versus Rupture

Cited by 29 publications

References 27 publications

Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study

Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study

Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study

Association of the age shock index with coronary plaque characteristics in ST‐segment elevation myocardial infarction: A 3‐vessel optical coherence tomography study

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