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(Circulation. 2008;118:2368-2373.)
© 2008 American Heart Association, Inc.

Imaging

Morphology of Exertion-Triggered Plaque Rupture in Patients With Acute Coronary Syndrome

An Optical Coherence Tomography Study

Atsushi Tanaka, MD, PhD; Toshio Imanishi, MD, PhD; Hironori Kitabata, MD; Takashi Kubo, MD, PhD; Shigeho Takarada, MD, PhD; Takashi Tanimoto, MD; Akio Kuroi, MD; Hiroto Tsujioka, MD; Hideyuki Ikejima, MD; Satoshi Ueno, MD; Hideaki Kataiwa, MD; Keishi Okouchi, MD; Manabu Kashiwaghi, MD; Hiroki Matsumoto, MD; Kazushi Takemoto, MT; Nobuo Nakamura, MD; Kumiko Hirata, MD, PhD; Masato Mizukoshi, MD, PhD; Takashi Akasaka, MD, PhD

From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Correspondence to Dr Atsushi Tanaka, Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan. E-mail a-tanaka{at}wakayama-med.ac.jp

Received March 26, 2008; accepted September 29, 2008.

Background— Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men who experienced sudden death. The aim of the present study was to use optical coherence tomography to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient’s activity at the onset of ACS.

Methods and Results— The study population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent optical coherence tomography and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. The thickness of the broken fibrous cap correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% versus exertion 93%, P=0.014). The thickness of the broken fibrous cap in the exertion group was significantly higher than in the rest-onset group (rest onset: 50 µm [interquartile median 15 µm]; exertion: 90 µm [interquartile median 65 µm], P<0.01).

Conclusions— The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest and during the patient’s day-to day activity, and some plaque rupture may occur in thick fibrous caps depending on exertion levels.

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