Plaque Rupture, compared to Plaque Erosion, is associated with Higher Level of Pan-coronary Inflammation

Abstract Background Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS). Inflammatory activation is considered a key mechanism of plaque instability in patients with plaque rupture through the release of metalloproteinases and the inhibition of collagen synthesis that in turns lead to fibrous cap degradation. However, the clinical relevance of macrophage infiltration has never been investigated in patients with PE. Purpose In our study, we aimed at assessing the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. Methods ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site and in non-culprit segments along the culprit vessel was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03–2.58) years]. Results We included 153 patients [median age (IQR) 64 (53–75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. In particular, culprit lesion analysis demonstrated that patients with PE with MØI had a significantly thinner fibrous cap [median (IQR) 100 (60–120) μm vs. 160 (95–190) μm, p<0.001], higher prevalence of thrombus [41 (80.4%) vs. 64 (62.7%), p=0.028], lipid plaque [39 (76.5%) vs. 50 (49.0%), p<0.001], TCFA [20 (39.2%) vs. 14 (13.7%), p=0.001], and a higher maximum lipid arc [median [IQR] 250.0° (177.5°-290.0°) vs. 190.0° (150.0°-260.0°), p=0.018) at the culprit lesion compared with PE without MØI. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p=0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression model, PE with MØI [HR=2.95, 95% CI (1.09–8.02), p=0.034] was an independent predictor of MACEs. Conclusion Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with a more aggressive phenotype of coronary atherosclerosis with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up. These findings are of the utmost importance in the era of precision medicine because clearly show that macrophage infiltrates may identify patients with a higher cardiovascular risk requiring more aggressive secondary prevention therapies and a closer clinical follow-up. Prognosis Funding Acknowledgement Type of funding source: None

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CARDIOVASCULAR DISEASES: PREVALENCE, RISK FACTORS (LITERATURE REVIEW)

Vestnik ◽

10.53065/kaznmu.2021.91.74.014 ◽

2021 ◽

pp. 84-92

Author(s):

М.О. Мустафина ◽

А. Телжанов ◽

З.Н. Лигай

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plaque Rupture ◽

Young Patients ◽

Microvascular Dysfunction ◽

Artery Dissection ◽

Variant Angina ◽

Coronary Artery Dissection ◽

Plaque Erosion

Мы провели поиск в PubMed статей, опубликованных с 1980 по 2020, используя термины «острый инфаркт миокарда», «молодой», «разрыв бляшки», эрозия бляшки, спонтанное расслоение коронарной артерии (SCAD), коронарный вазоспазм», «вариантная стенокардия или стенокардия Принцметала», «лекарственный инфаркт миокарда», «миокардит», «коронарная эмболия», «микрососудистая дисфункция», «MINOCA», а также обзор всех опубликованных исследований. Используя данные этого поиска, мы стремимся проинформировать читателей о распространенности, факторах риска, проявлениях и лечении острого инфаркта миокарда у молодых пациентов, а также подробно рассказать о специальных подгруппах с диагностическими и терапевтическими проблемами. We searched PubMed for articles published from 1980 to 2020 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant angina or angina pectoris. Prinzmetal, drug myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and a review of all published studies. Using the data from this search, we aim to inform readers about the prevalence, risk factors, manifestations and treatment of acute myocardial infarction in young patients, as well as detail the special subgroups with diagnostic and therapeutic problems.

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Histology-Based, Lesion-Specific Modeling of Stress Differences Between Plaque Rupture and Plaque Erosion

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53313 ◽

2011 ◽

Author(s):

Ian C. Campbell ◽

Renu Virmani ◽

John N. Oshinski ◽

W. Robert Taylor

Keyword(s):

Finite Element ◽

Plaque Rupture ◽

Solid Wall ◽

Element Model ◽

Blood Pool ◽

Future Studies ◽

Fibrous Cap ◽

Plaque Disruption ◽

Plaque Erosion ◽

Specific Modeling

Plaque erosion is a cause of thrombosis wherein a thrombus forms over an atherosclerotic plaque without any disruption of the fibrous cap. This is in contrast to plaque rupture, traditionally considered the main cause of atherosclerosis-related thrombosis and frequently studied in biomechanics, wherein the fibrous cap becomes disrupted and exposes the lipid core of the plaque to the blood pool. Also unlike plaque rupture, plaque erosion has been observed to happen most frequently in women [1]. Despite identification, the cause of plaque erosion remains unknown and has been virtually unstudied from a biomechanical perspective. In this study, we employ a unique high-resolution, histology-based finite element model of solid wall stresses to investigate biomechanical differences between plaque rupture and plaque erosion. In future studies, this computed stress distribution can be correlated to expression of biomarkers related to the plaque disruption process in order to investigate the cause of plaque erosion.

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P2651Seasonal variations in the pathogenesis of acute coronary syndromes

European Heart Journal ◽

10.1093/eurheartj/ehz748.0972 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O Kurihara ◽

M Takano ◽

E Yamamoto ◽

T Yonetsu ◽

T Kakuta ◽

...

Keyword(s):

Plaque Rupture ◽

Culprit Lesion ◽

Coronary Syndrome ◽

Plaque Erosion ◽

Four Seasons ◽

Incidence And Mortality ◽

Calcified Plaque ◽

Coronary Syndromes ◽

Underlying Mechanisms ◽

Underlying Pathophysiology

Abstract Background Seasonal variations in acute coronary syndrome (ACS) has been known with the winter being the peak in incidence and mortality. However, underlying pathophysiology for this variation has not been studied. Purpose We sought to compare pathobiology of the culprit lesions assessed by optical coherence tomography (OCT) among the four seasons. Methods Patients with ACS who underwent OCT were recruited from 6 countries in the Northern Hemisphere. The prevalence of 3 most common pathologies, plaque rupture, plaque erosion and calcified plaque, and other features of coronary plaques were compared among the four seasons. Results In 1113 patients with ACS, 284 (25%) patients were admitted in spring, 243 (22%) patients in summer, 290 (26%) patients in autumn and 296 (27%) patients in winter. The proportion of underlying 3 pathologies was significantly different in each season (prevalence of plaque rupture, plaque erosion, calcified plaque was 50%, 39%, and 11%, respectively in the spring; 44%, 43%, and 13% in the summer; autumn: 49%, 39%, and 12% in the autumn; 57%, 30%, and 13% in the winter; P=0.039). The proportion of plaque rupture was higher in winter but lower in summer, and that of plaque erosion was higher in summer, but lower in winter. Maximum and minimum temperatures on the day of OCT procedure were significantly lower in the plaque rupture group than in the plaque erosion group (P=0.02 and P=0.012, respectively). In the rupture group, the prevalence of hypertension was significantly higher in winter, but in the erosion group, it was not different among the four seasons. Figure 1. The proportion of culprit lesion characteristics were significantly different among the 4 season groups. (P=0.039) The proportion of plaque rupture was significantly higher in winter but lower in summer. In contrast, the proportion of plaque erosion was higher in summer, but lower in winter. Conclusions Seasonal variation of the underlying mechanisms of ACS reflects different pathobiology. The proportion of plaque rupture is highest in winter and the proportion of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence.

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Prevalence, Features, and Prognosis of Artery‐to‐Artery Embolic ST‐Segment–Elevation Myocardial Infarction: An Optical Coherence Tomography Study

Journal of the American Heart Association ◽

10.1161/jaha.120.017661 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Masahiro Takahata ◽

Yasushi Ino ◽

Takashi Kubo ◽

Takashi Tanimoto ◽

Akira Taruya ◽

...

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Plaque Rupture ◽

Optical Coherence ◽

Lumen Area ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Plaque Erosion ◽

St Segment ◽

Rupture Site

Background The major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery‐to‐artery embolic myocardial infarction (AAEMI) was defined as ST‐segment–elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography. Methods and Results This study retrospectively enrolled 297 patients with ST‐segment–elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm 2 [interquartile range (IQR), 2.2–4.9] versus 1.0 mm 2 [IQR, 0.8–1.3] versus 1.0 mm 2 [IQR, 0.8–1.2] versus 1.1 mm 2 [IQR, 0.7–1.6], P <0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm 2 [IQR, 2.5–6.7] versus 1.5 mm 2 [IQR, 1.0–2.4], P <0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm 2 (IQR, 1.0–2.1), 40% of them had nonstent strategy, and the 3‐year major adverse cardiac event rate was 0%. Conclusions AAEMI is a rare cause for ST‐segment–elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site.

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363 Old but fashioned: IVUS and chromaflo guidance for definition of thrombosis mechanism

European Heart Journal Supplements ◽

10.1093/eurheartj/suab134.047 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Gabriele Venturi ◽

Roberto Scarsini ◽

Gabriele Pesarini ◽

Michele Pighi ◽

Flavio Ribichini

Keyword(s):

Plaque Rupture ◽

Coronary Thrombosis ◽

Daily Practice ◽

Diagnostic Tools ◽

High Definition ◽

First Line ◽

Fibrous Cap ◽

Plaque Erosion ◽

Definition Of ◽

The Cost

Abstract Aims Plaque rupture and plaque erosion are the main causes of coronary thrombosis. While the first one involves fibrous cap disruption, the second one is caused by loss of endothelial continuity. In selected cases with evidence of plaque erosion, antithrombotic therapy without stenting has been suggested as a possible option. OCT is considered the gold standard for definition of thrombosis mechanism and has recently been included in algorithms for evaluation and management of patients with ACS. Also, high definition IVUS was compared with OCT in defining plaque erosion showing promising results. However, the cost and the large amount of contrast medium needed for OCT performance make these diagnostic tools of scarce applicability in daily practice. Methods and results We herein describe the case of a young man acceding to the Cath Lab with the diagnosis of NSTEMI. After baseline angiography and IVUS confirmed presence of Thrombus (Figure 1A and B), thromboaspiration was successfully performed (Figure 1D). The definition of thrombosis mechanism, revealing plaque rupture, was then performed with IVUS and ChromaFlo devices (Figure 1C and E). Also, IVUS was used to optimize stent implantation. Conclusions Although requiring further confirmations, we believe that in selected cases IVUS and ChromaFlo could provide a more applicable first-line diagnostic tool to define thrombosis mechanism. 363 Figure 1Baseline angiographic and IVUS evaluation confirming presence of coronary thrombus (A, B). After successful performance of thromboaspiration (D), plaque rupture was revealed by IVUS and ChromaFlo (C).

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99Non-ruptured plaque and platelet-rich thrombi in ST-segment elevation myocardial infarction: new insight into early spontaneous reperfusion

European Heart Journal ◽

10.1093/eurheartj/ehz747.0027 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Chen ◽

G Z Wang ◽

Z Liu ◽

Y H Zhang ◽

J C Guo ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Natural Science ◽

Plaque Rupture ◽

Control Group ◽

P Value ◽

Optical Coherence ◽

St Segment Elevation ◽

Plaque Erosion ◽

One Year ◽

And Control

Abstract Objectives To detect the potential mechanism of early spontaneous reperfusion (ESR) in STEMI. Background Early spontaneous reperfusion occurs in around 20% of STEMI and is associated with favorable outcomes. Optical coherence tomography (OCT) is more accurate in detecting subtle morphological details of the culprit lesion. Methods In this prospective study, a total of 107 consecutive patients with STEMI were enrolled from July 2016 to May 2017. Of that total, 21 (19.6%) met the criteria of angiographic ESR (TIMI-3 flow in the initial angiogram). Among those without ESR (TIMI-0 flow in the initial angiogram), 21 patients were assigned into the control group according to propensity score matching with the ESR group. The OCT findings and one-year clinical outcomes were compared between the two groups. Results Although baseline characteristics were comparable, plaque features significantly differed between the ESR and control group (P<0.001), including plaque rupture (23.8% vs. 66.7%), plaque erosion (47.6% vs. 33.3%), calcified nodule (9.5% vs. 0%) and vasospasm (19.1% vs. 0%). Red thrombus (19.1% vs. 85.7%) was far less found whereas white thrombus (61.9% vs. 14.3%) was more common in the ESR group. In addition, despite of less stent placement (0.6±0.5 vs. 1.3±0.9, P<0.001), patients in the ESR group had a non-statistically lower rate of cardiac adverse events (4.8% vs. 14.3%, P=0.269) during one-year follow up. The OCT finding Variables ESR group (n=21) Control group (n=21) P value The OCT imaging <0.001 Plaque erosion 10 (47.6) 7 (33.3) Plaque rupture 5 (23.8) 14 (66.7) Calcified nodule 2 (9.5) 0 (0) Vasospasm 4 (19.1) 0 (0) The Type of Thrombus <0.001 Red thrombus 4 (19.1) 18 (85.7) White thrombus 13 (61.9) 3 (14.3) No thrombus (vasospasm) 4 (19.1) 0 (0) MLA (mm2) 2.7±2.2 2.3±2.4 0.534 Values are n (%), mean ± SD. ESR = early spontaneous reperfusion; MLA = Minimum lumen area; OCT = optical coherence tomography. ESR and control group Conclusions Relief of coronary occlusion induced by non-ruptured plaque and platelet-rich thrombi may be one of the main mechanism underlying early spontaneous reperfusion in STEMI. Acknowledgement/Funding No.81470491 from the National Natural Science Foundation of China and No.7192078 from Beijing Municipal Natural Science Foundation to Dr. Li.

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Plaque Rupture and Plaque Erosion

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615543 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Allen P. Burke ◽

Andrew Farb ◽

Renu Virmani

Keyword(s):

Risk Factors ◽

Plaque Rupture ◽

Coronary Thrombosis ◽

Premenopausal Women ◽

Matrix Degradation ◽

Multiple Substrates ◽

Fibrous Cap ◽

Plaque Erosion ◽

Elevated Cholesterol ◽

Common Substrate

SummaryThere are multiple substrates for coronary thrombosis overlying an atherosclerotic plaque. The most common, plaque rupture, consists of an interruption of a thin fibrous cap overlying a lipid rich core. Plaque rupture is a result of macrophage infiltration and matrix degradation, is often seen in calcified plaques, and is highly associated with hypercholesterolemia. A less common substrate, plaque erosion, is not associated with elevated cholesterol and is the prime cause of coronary thrombosis in premenopausal women. The characteristic histologic features are abundant surface smooth muscle cells and proteoglycans, and a small or absent lipid rich core. The mechanisms of plaque erosion are unclear, and there are no consistent risk factors, although patients are often smokers.

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