Abstract 12399: Differences in Culprit Plaque Morphology in Patients with ST Elevation Myocardial Infarction versus Non ST Elevation Acute Coronary Syndrome: Optical Coherence Tomography Study
Objective: To compare the differences in the culprit plaque morphology between patients with ST elevation myocardial infarction (STEMI) and those with non ST elevation acute coronary syndrome (NSTE ACS).
Methods: A total of 403 patients were enrolled in this study: 108 with STEMI and 295 with NSTE ACS. All patients underwent OCT during the acute phase.
Results: Lipid plaques accounted for 92.6% and 86.1% of the culprit lesion in STEMI and NSTE ACS group, respectively. The STEMI patients had thinner fibrous cap (54.9±22.7 µm versus 75.4±38.7µm, P<0.001), greater lipid core arc (227.3±60.4°vs 213.6±55.6°,P<0.05) and longer lipid core length (15.6±6.8mm vs 13.3±7.4mm,P<0.01). The size of the ruptured cavity were greater in the STEMI than in the NSTE ACS group: depth (0.7±0.4.mm vs 0.6±0.5mm, P<0.05), the length (2.8±1.8mm vs 1.8±1.1mm, P<0.001) and average cross sectional area (0.9±0.7mm2 vs 0.6±0.6mm2,P<0.01). The rupture site was more frequently proximal to the minimal lumen in the STEMI group compared to the NSTE ACS group (74.6% vs 55.4%, P<0.05).
Conclusions Compared to the NSTE ACS, patients with STEMI had higher prevalence of plaque vulnerability and bigger ruptured cavity in the proximal portion of the culprit plaque. Figure OCT measurement of ruptured cavity showing the relationship between minimal luminal diameter (green arrow) and ruptured site (white arrow). A: site with minimal luminal area. Ruptured site without (B1) and with (B2) superimposed drawing. The lower panel shows longitudinal pull back image (right to left).
- Acute coronary syndromes
- Myocardial infarction, NSTEMI
- Myocardial infarction, STEMI
- Plaque rupture
- © 2011 by American Heart Association, Inc.