Rocco Vergallo1, Shiro Uemura1, Tsunenari Soeda1, Yoshiyasu Minami1, Jin-Man Cho1, Daniel S Ong1, Aaron D Aguirre1, Lei Gao1, Luigi M Biasucci1, Filippo Crea1, Bo Yu2, Hang Lee1, Chong-Jin Kim1, Ik-Kyung Jang2. 1. From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.). 2. From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.). ijang@mgh.harvard.edu yubodr@163.com.
Abstract
OBJECTIVE: Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures. APPROACH AND RESULTS: Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039). CONCLUSIONS: Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.
OBJECTIVE: Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures. APPROACH AND RESULTS: Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039). CONCLUSIONS: Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.
Authors: Makoto Araki; Seung-Jung Park; Harold L Dauerman; Shiro Uemura; Jung-Sun Kim; Carlo Di Mario; Thomas W Johnson; Giulio Guagliumi; Adnan Kastrati; Michael Joner; Niels Ramsing Holm; Fernando Alfonso; William Wijns; Tom Adriaenssens; Holger Nef; Gilles Rioufol; Nicolas Amabile; Geraud Souteyrand; Nicolas Meneveau; Edouard Gerbaud; Maksymilian P Opolski; Nieves Gonzalo; Guillermo J Tearney; Brett Bouma; Aaron D Aguirre; Gary S Mintz; Gregg W Stone; Christos V Bourantas; Lorenz Räber; Sebastiano Gili; Kyoichi Mizuno; Shigeki Kimura; Toshiro Shinke; Myeong-Ki Hong; Yangsoo Jang; Jin Man Cho; Bryan P Yan; Italo Porto; Giampaolo Niccoli; Rocco A Montone; Vikas Thondapu; Michail I Papafaklis; Lampros K Michalis; Harmony Reynolds; Jacqueline Saw; Peter Libby; Giora Weisz; Mario Iannaccone; Tommaso Gori; Konstantinos Toutouzas; Taishi Yonetsu; Yoshiyasu Minami; Masamichi Takano; O Christopher Raffel; Osamu Kurihara; Tsunenari Soeda; Tomoyo Sugiyama; Hyung Oh Kim; Tetsumin Lee; Takumi Higuma; Akihiro Nakajima; Erika Yamamoto; Krzysztof L Bryniarski; Luca Di Vito; Rocco Vergallo; Francesco Fracassi; Michele Russo; Lena M Seegers; Iris McNulty; Sangjoon Park; Marc Feldman; Javier Escaned; Francesco Prati; Eloisa Arbustini; Fausto J Pinto; Ron Waksman; Hector M Garcia-Garcia; Akiko Maehara; Ziad Ali; Aloke V Finn; Renu Virmani; Annapoorna S Kini; Joost Daemen; Teruyoshi Kume; Kiyoshi Hibi; Atsushi Tanaka; Takashi Akasaka; Takashi Kubo; Satoshi Yasuda; Kevin Croce; Juan F Granada; Amir Lerman; Abhiram Prasad; Evelyn Regar; Yoshihiko Saito; Mullasari Ajit Sankardas; Vijayakumar Subban; Neil J Weissman; Yundai Chen; Bo Yu; Stephen J Nicholls; Peter Barlis; Nick E J West; Armin Arbab-Zadeh; Jong Chul Ye; Jouke Dijkstra; Hang Lee; Jagat Narula; Filippo Crea; Sunao Nakamura; Tsunekazu Kakuta; James Fujimoto; Valentin Fuster; Ik-Kyung Jang Journal: Nat Rev Cardiol Date: 2022-04-21 Impact factor: 49.421
Authors: Tomoyo Sugiyama; Erika Yamamoto; Krzysztof Bryniarski; Lei Xing; Hang Lee; Mitsuaki Isobe; Peter Libby; Ik-Kyung Jang Journal: JAMA Cardiol Date: 2018-03-01 Impact factor: 14.676
Authors: Tomoyo Sugiyama; Erika Yamamoto; Krzysztof Bryniarski; Lei Xing; Francesco Fracassi; Hang Lee; Ik-Kyung Jang Journal: J Am Heart Assoc Date: 2018-07-13 Impact factor: 5.501