Abstract 11408: Morphometric Features of Coronary Calcifications of Culprit Plaques in Patients With Acute Coronary Syndrome: Assessment by Optical Coherence Tomography
Background: Coronary calcification is associated with the development of coronary atherosclerotic plaque, although whether coronary calcification is associated with plaque vulnerability remains controversial. This study aimed to determine the morphometric features of coronary calcifications in culprit plaques in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT).
Methods: We evaluated the characteristics of 127 culprit lesions using OCT and intravascular ultrasound (IVUS) in stable angina pectoris (SAP) (n = 92) and ACS (n = 35). Morphologic and quantitative analyses of coronary calcifications were performed by OCT within a 20-mm segment that spanned the minimum lumen area site, and were compared between SAP and ACS groups. In each calcification, cross-sectional maximum area, longitudinal length, and distance from the lumen were measured. Maximum arc of each calcification was calculated with a protractor centered on the lumen. Spotty calcifications were defined as those with maximum area ≤0.08 mm2 (median maximum area), and were counted. The presence of thin-cap fibroatheroma (TCFA), plaque rupture, and thrombus were assessed by OCT, and cross-sectional vessel, plaque area, and remodeling index were measured by IVUS.
Results: Maximum area, maximum arc, and length of calcifications were significantly smaller in the ACS group than in the SAP group (P < 0.001 each). Mean number of spotty calcifications per lesion was significantly larger in the ACS group (2.20 ± 2.03) than in the SAP group (1.18 ± 1.47, P = 0.007). The number of spotty calcifications per lesion correlated positively with plaque area (R = 0.195, P = 0.035) and remodeling index (R = 0.206, P = 0.025). Multivariate logistic regression analysis identified thrombus (odds ratio (OR), 24.03; 95% confidence interval (CI), 6.75-85.61, P < 0.001), TCFA (OR, 5.84; 95%CI, 1.37-24.93, P = 0.017), and number of spotty calcifications per lesion (OR, 1.49; 95%CI, 1.06-2.08, P = 0.021) as significant characteristics associated with culprit plaques in ACS.
Conclusion: Coronary calcifications with smaller area and shorter length, particularly larger number of spotty calcifications, appear to represent features of culprit plaques in ACS patients.
- © 2013 by American Heart Association, Inc.