Clinical Predictors of Culprit Plaque Rupture Assessed on Intravascular Ultrasound in Acute Coronary Syndrome

Single center studies have shown that plaque rupture and positive remodeling are prognostic predictors of acute coronary syndrome (ACS). A total of 119 patients with first ACS events were enrolled in a multicenter, prospective, 3-vessel intravascular ultrasound (IVUS) registry. Pre-intervention IVUS imaging was performed in 98 patients. Remodeling index was defined as lesion site external elastic membrane cross sectional area (EEM CSA) divided by the proximal reference. Arterial remodeling was defined as either positive (PR; remodeling index >1.05) or intermediate/negative (IR/NR; remodeling index <1.05). Plaque rupture was a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Major adverse cardiac events (MACE) were death, myocardial infarction (MI), and target lesion revascularization (TLR). During follow-up (mean 3 years), 20 TLR events and 5 deaths were documented; but recurrent MI was not observed. Patients with PR had significantly lower MACE-free survival than patients with IR/NR (Log rank, p=0.03). Similarly, patients with plaque rupture showed a non-significant trend toward lower MACE-free survival (Log rank, p=0.13). By multivariate logistic regression analysis, culprit lesion PR was the only independent predictor of follow-up MACE. Culprit lesion remodeling is a strong predictor of long-term clinical outcome in patients with ACS.

Download Full-text

Clinical and morphological presentations of acute coronary syndrome without coronary plaque rupture — An intravascular ultrasound study

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.06.191 ◽

2016 ◽

Vol 220 ◽

pp. 112-115

Author(s):

Kenichi Tsujita ◽

Kenshi Yamanaga ◽

Naohiro Komura ◽

Kenji Sakamoto ◽

Takashi Miyazaki ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Intravascular Ultrasound ◽

Plaque Rupture ◽

Coronary Plaque ◽

Coronary Syndrome ◽

Ultrasound Study

Download Full-text

Acute coronary syndrome demonstrating plaque rupture in calcified plaque visualized by optical coherence tomography and near-infrared spectroscopy combined with intravascular ultrasound

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.04.002 ◽

2021 ◽

Author(s):

Yoshitaka Sasahira ◽

Teruyoshi Kume ◽

Satoshi Koto ◽

Okamoto Hiroshi ◽

Ryotaro Yamada ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Infrared Spectroscopy ◽

Intravascular Ultrasound ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Plaque Rupture ◽

Optical Coherence ◽

Coronary Syndrome ◽

Calcified Plaque

Download Full-text

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.1250 ◽

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<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

Download Full-text

Coronary lipid-rich plaque characteristics in Japanese patients with acute coronary syndrome and stable angina: A near infrared spectroscopy and intravascular ultrasound study

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100747 ◽

2021 ◽

Vol 33 ◽

pp. 100747

Author(s):

Norihito Takahashi ◽

Tomotaka Dohi ◽

Hirohisa Endo ◽

Mitsuhiro Takeuchi ◽

Shinichiro Doi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Infrared Spectroscopy ◽

Intravascular Ultrasound ◽

Near Infrared Spectroscopy ◽

Stable Angina ◽

Near Infrared ◽

Japanese Patients ◽

Coronary Syndrome ◽

Ultrasound Study ◽

Lipid Rich Plaque

Download Full-text

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0321 ◽

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<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<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<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<0.001), and the thickness of broken fibrous cap was significantly thinner (40 (30–50) vs. 80 (67.5–100) μm, p<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

Download Full-text