THE RESULTS OF URGENT CORONARY ANGIOGRAPHY AND STENTING IN THE ACUTE CORONARY SYNDROME

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

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Evaluation of Gender Variation in Plaque Morphology and Plaque Distribution in Acute Coronary Syndrome Patients by Coronary Angiography and Optical Coherence Tomography

Indian Heart Journal ◽

10.1016/j.ihj.2019.11.093 ◽

2019 ◽

Vol 71 ◽

pp. S45

Author(s):

K.P. Nevali ◽

S. Reddy

Keyword(s):

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Coronary Angiography ◽

Plaque Morphology ◽

Optical Coherence ◽

Coronary Syndrome ◽

Gender Variation

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Cholesterol-crystalized coronary atheroma as a potential precursor lesion causing acute coronary syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz128 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Hiroki Sugane ◽

Yu Kataoka ◽

Fumiyuki Otsuka ◽

Satoshi Yasuda

Keyword(s):

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Coronary Angiography ◽

Atherosclerotic Plaques ◽

Culprit Lesion ◽

Cholesterol Crystals ◽

Coronary Syndrome ◽

Obstructive Lesion ◽

Coronary Events ◽

Potential Precursor

Abstract Background Histopathological studies have reported the presence of cholesterol crystals in the culprit lesion in patients with sudden cardiac death. Given that cholesterol crystals themselves promote pro-inflammatory cascades, they may destabilize atherosclerotic plaques, leading to the occurrence of acute coronary events. Case summary A 60-year-old man presented with ST-segment elevation myocardial infarction. Emergent coronary angiography revealed a severely stenotic lesion (=culprit lesion) and another non-obstructive lesion in the proximal and middle segments of the left anterior descending artery (LAD), respectively. Optical coherence tomography (OCT) imaging showed that both lesions exhibited lipid-rich plaque with cholesterol crystals, and the non-obstructive lesion in the mid-LAD did not have a thin fibrous cap (its thickness = 230 μm). A drug-eluting stent was successfully implanted at the culprit lesion in the proximal LAD. On non-contrast T1-weighted magnetic resonance imaging performed 10 days after percutaneous coronary intervention (PCI), a high-intensity signal was identified at the non-obstructive mid-LAD lesion. This lesion was medically managed with aspirin, clopidogrel, and rosuvastatin due to the absence of myocardial ischaemia. However, 12 months after PCI, the patient was hospitalized again due to unstable angina pectoris. Coronary angiography revealed substantial progression of the mid-LAD lesion. Optical coherence tomography imaging prior to the second PCI showed a severely narrowed lesion containing cholesterol crystals and covered by organized thrombus. This lesion harbored an extensive amount of lipidic materials on near-infrared spectroscopy (maximum 4-mm lipid core burden index = 809). Discussion In our case, atherosclerotic plaques containing cholesterol crystals was associated with the occurrence of acute coronary syndrome. Our findings suggest that plaque with cholesterol crystals is a potential precursor to future acute coronary events.

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