Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study

Introduction: Autopsy studies in sudden cardiac death subjects showed female had higher incidence of erosion. However, the incidence of erosion in patients with acute myocardial infarction (AMI) has not been systematically studied. Hypothesis: This study was to study the gender difference in the prevalence and morphological characteristics of the culprit lesion in patients with AMI using intravascular optical coherence tomography (OCT). Methods: A total of 79 patients (65 male and 14 female) with AMI who underwent pre-intervention OCT imaging of the culprit lesion were included. Results: Baseline characteristics between the two groups were similar. In OCT findings, the incidence of thin-cap fibroatheroma (TCFA) was slightly lower and the fibrous cap thickness was slightly thicker in female than in male, but the differences were not significant. Defining underlying plaque morphology by genders, plaque erosion was more prevalent in female than in male, whereas plaque rupture was more frequent in male (Table). Conclusions: Erosion was the most frequent cause of AMI in female patients, whereas plaque rupture is the predominant underlying pathology of AMI in male patients.

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Abstract 1988: Non-culprit Coronary Plaque Morphology in Patients WIth Acute Myocardial Infarction : An Optical Coherence Tomography Study in Vivo

Circulation ◽

10.1161/circ.116.suppl_16.ii_429-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kenichi Fujii ◽

Motomaru Masutani ◽

Takahiro Okumura ◽

Daizo Kawasaki ◽

Takafumi Akagami ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Optical Coherence Tomography ◽

Plaque Rupture ◽

Plaque Morphology ◽

List Type ◽

Optical Coherence ◽

Fibrous Cap ◽

Infarct Related Artery

Background: In vivo imaging studies in patients with acute myocardial infarction (AMI) have demonstrated important lesions at sites other than the culprit. However, it is not well assessed whether non-culprit plaques in the non-infarct-related artery have similar markers of plaque instability compared to non-culprit plaques in the infarct-related artery. The aim of this study is to investigate the morphologic features of the non-culprit plaque in infarct-related artery in comparison with that in non-infarct-related artery for AMI patients using optical coherence tomography (OCT) in vivo. Methods: OCT examinations were attempted prospectively using motorized pullback in all 3 major coronary arteries (at least 2/3 segment of each artery) for 34 AMI patients. In 34 patients, 118 focal plaques were identified (3.5 plaques per patient). Qualitative OCT analyses for each focal atherosclerotic plaque were performed using the previously validated criteria. TCFA was defined as a plaque with lipid content in a quadrant and the thinnest part of a fibrous cap measuring <65 μm. A plaque rupture contained a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. A thrombus was defined as an irregular mass protruding into the lumen. Non-culprit plaques were divided into two groups according to their location: plaques in infarct-related artery (n=35) and plaques in non-infarct-related artery (n=83). Results: Non-culprit TCFA, plaque rupture, and thrombus were observed in 50 lesions of 26 patients (76%), 14 lesions of 11 patients (34%), and 27 lesions of 15 patients (44%), respectively. OCT analyses are shown in the Table . Conclusions: The morphology of non-culprit plaques in AMI patients is similar whether these plaques occur in the infarct-related artery or the non-infarct-related artery. This suggests that plaque destabilization is a systemic phenomenon rather than a local, artery-specific process. OCT Analyses

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