Abstract 12492: Multimodality Intravascular Imaging Assessment of Plaque Erosion vs Plaque Rupture in Patients With Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sang-Wook Kim ◽  
Hoyoun Won ◽  
Gary S Mintz ◽  
Young Joon Hong ◽  
Sung Yun Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Elastic Membrane ◽  
Lesion Length ◽  
Intravascular Imaging ◽  
Lumen Area ◽  
Membrane Area ◽  
Coronary Syndrome ◽  
Plaque Erosion ◽  
Minimal Lumen Area

We used optical coherent tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS) to assess culprit lesions in 146 Korean pts with acute coronary syndrome (ACS). Methods: Culprit lesion plaque rupture (PR) or plaque erosion (PE) was diagnosed with OCT; and IVUS was used to determine arterial remodeling. PE (n=56) was the presence of intracoronary thrombus attached to the luminal surface with no detectable signs of fibrous cap rupture that was seen in 90 ACS pts with PR. Positive remodeling was a remodeling index (lesion/reference EEM [external elastic membrane] area) >1.05. Results: Pt age was 60±12 yrs in PR and 62±11 yrs in PE; 19% of PR vs 18% of PE were females. Overall, 25% (14/56) of PE had non-ST elevation myocardial infarction (NSTEMI) and 34% (19/56) had STEMI; conversely, 14.4% (13/90) of PR had NSTEMI and 71% (64/90) had STEMI (p<0.0001). Vessel size, minimal lumen area, and lumen area at the PR or PE site were similar; however, lesion length was longer in PR. Plaque area was smaller with negative remodeling in PE while PR showed positive remodeling with a larger necrotic core area by VH-IVUS (Table). By OCT, PE were fibrotic in 50% (28/56), fibrocalcific in 16% (9/56), and lipidic in 32.1% (18/56, all but one of which was a thick cap fibroatheroma). Conclusion: Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion in Asian pts.

scholarly journals Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

2016 ◽  
Vol 46 (4) ◽  
pp. 499 ◽  
Author(s):  
Jee Eun Kwon ◽  
Wang Soo Lee ◽  
Gary S. Mintz ◽  
Young Joon Hong ◽  
Sung Yun Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Intravascular Imaging ◽  
Coronary Syndrome ◽  
Plaque Erosion

Macrophage infiltrates in coronary plaque erosion portend a worse cardiovascular outcome in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.A Montone ◽  
V Vetrugno ◽  
M Camilli ◽  
M Russo ◽  
M.G Del Buono ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Vulnerable Plaque ◽  
Cardiac Death ◽  
Cox Regression ◽  
Plaque Rupture ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Plaque Erosion

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&lt;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&lt;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

scholarly journals Potential relationship between high wall shear stress and plaque rupture that cause acute coronary syndrome: insights from optical coherence tomography based computational fluid dynamic simulation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Fukuyama ◽  
H Otake ◽  
F Seike ◽  
H Kawamori ◽  
T Toba ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Shear Stress ◽  
Acute Coronary Syndrome ◽  
Wall Shear Stress ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Lumen Area ◽  
Segmental Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background The direct relationship between plaque rupture (PR) that cause acute coronary syndrome (ACS) and wall shear stress (WSS) remains uncertain. Methods From the Kobe University ACS-OCT registry, one hundred ACS patients whose culprit lesions had PR documented by optical coherence tomography (OCT) were enrolled. Lesion-specific 3D coronary artery models were created using OCT data. Specifically, at the ruptured portion, the tracing of the luminal edge of the residual fibrous cap was smoothly extrapolated to reconstruct the luminal contour before PR. Then, WSS was computed from computational fluid dynamics (CFD) analysis by a single core laboratory. Relationships between WSS and the location of PR were assessed with 1) longitudinal 3-mm segmental analysis and 2) circumferential analysis. In the longitudinal segmental analysis, each culprit lesion was subdivided into five 3-mm segments with respect to the minimum lumen area (MLA) location at the centered segment (Figure. 1). In the circumferential analysis, we measured WSS values at five points from PR site and non-PR site on the cross-sections with PR. Also, each ruptured plaque was categorized into the lateral type PR (L-PR), central type PR (C-PR), and others according to the relation between the site of tearing and the cavity (Figure. 2). Results In the longitudinal 3-mm segmental analysis, the incidences of PR at upstream (UP1 and 2), MLA, and downstream (DN1 and 2) were 45%, 40%, and 15%, respectively. The highest average WSS was located in UP1 in the upstream PR (UP1: 15.5 (10.4–26.3) vs. others: 6.8 (3.3–14.7) Pa, p&lt;0.001) and MLA segment in the MLA PR (MLA: 18.8 (6.0–34.3) vs. others: 6.5 (3.1–11.8) Pa, p&lt;0.001), and the second highest WSS was located at DN1 in the downstream PR (DN1: 5.8 (3.7–11.5) vs. others: 5.5 (3.7–16.5) Pa, p=0.035). In the circumferential analysis, the average WSS at PR site was significantly higher than that of non-PR site (18.7 (7.2–35.1) vs. 13.9 (5.2–30.3) Pa, p&lt;0.001). The incidence of L-PR, C-PR, and others were 51%, 42%, and 7%, respectively. In the L-PR, the peak WSS was most frequently observed in the lateral site (66.7%), whereas that in the C-PR was most frequently observed in the center site (70%) (Figure. 3). In the L-PR, the peak WSS value was significantly lower (44.6 (19.6–65.2) vs. 84.7 (36.6–177.5) Pa, p&lt;0.001), and the thickness of broken fibrous cap was significantly thinner (40 (30–50) vs. 80 (67.5–100) μm, p&lt;0.001), and the lumen area at peak WSS site was significantly larger than those of C-PR (1.5 (1.3–2.0) vs. 1.4 (1.1–1.6) mm2, p=0.008). Multivariate analysis demonstrated that the presence of peak WSS at lateral site, thinner broken fibrous cap thickness, and larger lumen area at peak WSS site were independently associated with the development of the L-PR. Conclusions A combined approach with CFD simulation and morphological plaque evaluation by using OCT might be helpful to predict future ACS events induced by PR. Funding Acknowledgement Type of funding source: None

scholarly journals CRT-101 Spatial Assessment of Plaque Erosion In Patients With Acute Coronary Syndrome Using Multimodality Intravascular Imaging.

2015 ◽  
Vol 8 (2) ◽  
pp. S8-S9
Author(s):  
Sang Wook Kim ◽  
Hoyoun Won ◽  
Gary S. Mintz ◽  
Neil J. Weissman ◽  
Young Joon Hong ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Intravascular Imaging ◽  
Spatial Assessment ◽  
Coronary Syndrome ◽  
Plaque Erosion

scholarly journals Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Xing Luo ◽  
Ying Lv ◽  
Xiaoxuan Bai ◽  
Jinyu Qi ◽  
Xiuzhu Weng ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Plaque Rupture ◽  
Accurate Diagnosis ◽  
Coronary Syndrome ◽  
Pathological Characteristics ◽  
Vulnerable Plaques ◽  
Plaque Erosion ◽  
Pathological Mechanism ◽  
Clinical Strategies

Plaque erosion (PE) is one of the most important pathological mechanisms underlying acute coronary syndrome (ACS). The incidence of PE is being increasingly recognized owing to the development and popularization of intracavitary imaging. Unlike traditional vulnerable plaques, eroded plaques have unique pathological characteristics. Moreover, recent studies have revealed that there are differences in the physiopathological mechanisms, biomarkers, and clinical outcomes between PE and plaque rupture (PR). Accurate diagnosis and treatment of eroded plaques require an understanding of the pathogenesis of PE. In this review, we summarize recent scientific discoveries of the pathological characteristics, mechanisms, biomarkers, clinical strategies, and prognosis in patients with PE.

Abstract 17826: Age Difference in Plaque Characteristics of Culprit Lesions in Patients with Acute Coronary Syndrome: an Optical Coherence Tomography Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Haibo Jia ◽  
Sining Hu ◽  
Tsunenari Soeda ◽  
Rocco Vergallo ◽  
Yoshiyasu Minami ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Plaque Morphology ◽  
Age Difference ◽  
Age Group ◽  
Coronary Syndrome ◽  
Plaque Erosion ◽  
Younger Age ◽  
Group A ◽  
Group B

Introduction: The relationship between age and culprit plaque characteristics in patients with acute coronary syndrome (ACS) has not been reported. Hypothesis: The characteristics of the culprit plaques differ between younger population and older population with ACS. Methods: We studied 154 patients with ACS who underwent OCT imaging before intervention. The distribution and plaque morphology of the culprit lesion were compared according to the age: Group A (65 years, n=44). Results: There were more smokers in Group A than in Group B and C (58.3% vs. 36.5% vs. 15.9%, p<0.001). Plaque erosion was more frequently observed in the younger age group, whereas plaque rupture was more frequent in the older age group (Figure). The prevalence of calcified nodule was not different among the three groups (Figure). Other features of thin-cap fibroatheroma, thrombus, and macrophage infiltration showed no differences among the three groups. Conclusions: Plaque erosion was the primary cause for ACS in younger patients, whereas plaque rupture was more commonly observed in older patients.

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

2018 ◽  
Vol 3 (3) ◽  
pp. 207 ◽  
Author(s):  
Tomoyo Sugiyama ◽  
Erika Yamamoto ◽  
Krzysztof Bryniarski ◽  
Lei Xing ◽  
Hang Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Coronary Syndrome ◽  
Plaque Erosion

scholarly journals Plaque erosion is associated with less systemic atherosclerosis than other plaque types of acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kato ◽  
Y Minami ◽  
K Asakura ◽  
M Katamine ◽  
A Katsura ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Aortic Arch ◽  
Plaque Rupture ◽  
Intima Media Thickness ◽  
Atheromatous Plaque ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Plaque Erosion ◽  
The Status ◽  
Chest X Ray

Abstract Background Previous studies have demonstrated that plaque erosion is associated with less atheromatous plaque at both culprit and non-culprit lesion than other plaque types of acute coronary syndrome (ACS). However, the status of systemic atherosclerosis in patients with plaque erosion remains to be elucidated. Purpose To clarify if plaque erosion is associated with less systemic atherosclerosis than other plaque types of ACS. Methods A total of 239 consecutive patients with ACS who underwent optical coherence tomography (OCT) imaging of the culprit lesion were enrolled. Patients were classified into either plaque erosion (PE, n=45) or non-plaque erosion (non-PE, n=194) including plaque rupture and calcified nodule based on OCT findings of the culprit lesions. The status of systemic atherosclerosis was assessed by the findings of carotid echography, the severity of aortic arch calcification (AAC; grade 0–3) on chest X-ray, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABPI). Results The maximum intima media thickness (IMT) was significantly thinner in the PE group than in the non-PE group (1.9±0.8 vs. 2.3±0.9 mm, p=0.023) (Panel A). The prevalence of heterogeneous plaque and calcified plaque was significantly lower in the PE group than in the non-PE group (25.0 vs. 50.4%, p=0.010, 18.8 vs. 38.5%, p=0.037, respectively). The prevalence of AAC grade was significantly different between the two groups with a tendency toward lower AAC grade in the PE group than the non-PE group (Panel B). The mean baPWV (1588.1±420.6 vs. 1686.5±363.5 cm/sec, p=0.186) and ABPI (1.1±0.1 vs. 1.1±0.1, p=0.270) was comparable between the two groups. Conclusion Plaque erosion was associated with less atherosclerosis in carotid artery and aortic arch than non-plaque erosion. These findings may help further clarify the distinct pathophysiology of plaque erosion. Funding Acknowledgement Type of funding source: None

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