Abstract 4189: Evaluation of Coronary Plaque Rupture in Patients With Chronic Coronary Artery Disease: Optical Coherence Tomography Study
Background: Coronary plaque rupture (CPR) has a pivotal role in the onset of acute coronary events. However, it is reported that CPR also occurs in non-culprit lesions in patients with acute coronary syndrome when visualized by optical coherence tomography (OCT). Nonetheless, detailed information such as the incidence and the location of CPR in unselected patients with chronic coronary artery disease (CAD) remains unavailable.
Objective: We assessed the incidence and characteristics of CPR in patients with CAD, and compared the clinical characteristics of patients with and without CPR.
Methods: OCT was performed in 20 consecutive patients with CAD before coronary intervention. OCT imaging was performed during occlusion of the proximal coronary artery with a compliant balloon and continuous flushing. A 0.016-inch OCT catheter was used (Image wire®, LightLab Imaging). Patients were divided into two groups, with and without CPR. We compared clinical characteristics and CPR location site between the two groups.
Results: CPR incidence was observed in 12 of the 20 patients (60%), 11 of whom had multiple CPR in the target lesion, whereas single CPR was observed in only the one remaining case. Prior myocardial infarction was seen in 4 of 8 cases in the non-CPR group (50%), but only in one of the 12 in the CPR group (8%). CPR were observed at 11 points (24%) in the proximal one third (site A), 17 (38%) in the central one third of the target lesion (site B), and only 4 (9%) in the distal one third (site C). Moreover, CPR was observed at 6 points (13%) in proximal (site D) and 7 (15%) in distal non-target remote lesions (site E). Thin cap thickness of CPR was not significantly different between the groups (site A+B+D; 0.085±0.055 vs. site C+E; 0.064±0.016 mm: p=NS).
Conclusions: CPR is not a rare phenomenon in patients with chronic CAD, especially in patients without prior myocardial infarction. Moreover, multiple CPR are commonly present upstream of coronary blood flow.