Jinwei Tian1, Xuefeng Ren2, Rocco Vergallo3, Lei Xing2, Huai Yu2, Haibo Jia1, Tsunenari Soeda3, Iris McNulty3, Sining Hu1, Hang Lee4, Bo Yu5, Ik-Kyung Jang3. 1. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. 3. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 4. Biostatistic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 5. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.
Abstract
OBJECTIVES: The study sought to identify specific morphological characteristics of ruptured culprit plaques (RCP) responsible for acute events, and compare them with ruptured nonculprit plaques (RNCP) and nonruptured thin-cap fibroatheroma (TCFA) in patients presenting with acute coronary syndromes (ACS). BACKGROUND: Nonruptured TCFA and multiple ruptured plaques are detected in the same patients with ACS. It remains unknown whether certain morphological characteristics determine rupture of TCFA and subsequently result in ACS. METHODS: We analyzed 126 plaques (RCP = 49, RNCP = 19, TCFA = 58) from 82 ACS patients using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Fibrous cap thickness was determined by OCT. Plaque burden and lumen area were measured with IVUS. RESULTS: Fibrous cap was thinner in RCP (43 ± 11 μm) and RNCP (41 ± 10 μm) than in TCFA (56 ± 9 μm, p < 0.001 and p < 0.001, respectively). Plaque burden was greater in RCP (82 ± 7.2%), compared with RNCP (64 ± 7.2%, p < 0.001) and TCFA (62 ± 12.5%, p < 0.001). Lumen area was smaller in RCP (2.1 ± 0.9 mm(2)), compared with RNCP (4.6 ± 2.3 mm(2), p = 0.001) and TCFA (5.1 ± 2.7 mm(2), p < 0.001). The fibrous cap thickness <52 μm had good performance in discriminating ruptured plaque from TCFA (area under the curve [AUC] = 0.857, p < 0.001), and plaque burden >76% and lumen area <2.6 mm(2) had good performance in discriminating RCP from RNCP and TCFA (AUC = 0.923, p < 0.001 and AUC = 0.881, p < 0.001, respectively). CONCLUSIONS: Fibrous cap thickness is a critical morphological discriminator between ruptured plaques and nonruptured TCFA, while plaque burden and lumen area appear to be important morphological features of RCP. These findings suggest that plaque rupture is determined by fibrous cap thickness, and a combination of large plaque burden and luminal narrowing result in ACS.
OBJECTIVES: The study sought to identify specific morphological characteristics of ruptured culprit plaques (RCP) responsible for acute events, and compare them with ruptured nonculprit plaques (RNCP) and nonruptured thin-cap fibroatheroma (TCFA) in patients presenting with acute coronary syndromes (ACS). BACKGROUND: Nonruptured TCFA and multiple ruptured plaques are detected in the same patients with ACS. It remains unknown whether certain morphological characteristics determine rupture of TCFA and subsequently result in ACS. METHODS: We analyzed 126 plaques (RCP = 49, RNCP = 19, TCFA = 58) from 82 ACS patients using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Fibrous cap thickness was determined by OCT. Plaque burden and lumen area were measured with IVUS. RESULTS: Fibrous cap was thinner in RCP (43 ± 11 μm) and RNCP (41 ± 10 μm) than in TCFA (56 ± 9 μm, p < 0.001 and p < 0.001, respectively). Plaque burden was greater in RCP (82 ± 7.2%), compared with RNCP (64 ± 7.2%, p < 0.001) and TCFA (62 ± 12.5%, p < 0.001). Lumen area was smaller in RCP (2.1 ± 0.9 mm(2)), compared with RNCP (4.6 ± 2.3 mm(2), p = 0.001) and TCFA (5.1 ± 2.7 mm(2), p < 0.001). The fibrous cap thickness <52 μm had good performance in discriminating ruptured plaque from TCFA (area under the curve [AUC] = 0.857, p < 0.001), and plaque burden >76% and lumen area <2.6 mm(2) had good performance in discriminating RCP from RNCP and TCFA (AUC = 0.923, p < 0.001 and AUC = 0.881, p < 0.001, respectively). CONCLUSIONS: Fibrous cap thickness is a critical morphological discriminator between ruptured plaques and nonruptured TCFA, while plaque burden and lumen area appear to be important morphological features of RCP. These findings suggest that plaque rupture is determined by fibrous cap thickness, and a combination of large plaque burden and luminal narrowing result in ACS.
Authors: Hyuk-Jae Chang; Fay Y Lin; Sang-Eun Lee; Daniele Andreini; Jeroen Bax; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J W Chow; Edoardo Conte; Ricardo C Cury; Gudrun Feuchtner; Martin Hadamitzky; Yong-Jin Kim; Jonathon Leipsic; Erica Maffei; Hugo Marques; Fabian Plank; Gianluca Pontone; Gilbert L Raff; Alexander R van Rosendael; Todd C Villines; Harald G Weirich; Subhi J Al'Aref; Lohendran Baskaran; Iksung Cho; Ibrahim Danad; Donghee Han; Ran Heo; Ji Hyun Lee; Asim Rivzi; Wijnand J Stuijfzand; Heidi Gransar; Yao Lu; Ji Min Sung; Hyung-Bok Park; Daniel S Berman; Matthew J Budoff; Habib Samady; Leslee J Shaw; Peter H Stone; Renu Virmani; Jagat Narula; James K Min Journal: J Am Coll Cardiol Date: 2018-06-05 Impact factor: 24.094
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