Abstract 13152: Pancoronary Plaque Vulnerability in Patients With Acute Coronary Syndrome and Ruptured Culprit Plaque: A Three-Vessel Optical Coherence Tomography Study
Introduction: Previous studies suggest that plaque rupture may represent not merely a focal vascular event but the expression of a generalized inflammatory response with pancoronary plaque destabilization.
Hypothesis: We hypothesized that patients with plaque rupture at the culprit lesion may have pancoronary vulnerability. In the present study, we sought to compare non-culprit coronary plaque characteristics between patients with and without plaque rupture at the culprit site.
Methods: Based on culprit plaque morphology, 38 patients with acute coronary syndrome (ACS) who underwent 3-vessel optical coherence tomography (OCT) imaging were divided into ruptured plaque (RP) and non-ruptured plaque (NRP) groups. Prevalence and features of non-culprit plaques were compared between the two groups.
Results: A total of 118 non-culprit plaques were analyzed. Compared to the patients in the NRP group (n=21), those in the RP group (n=17) had higher prevalence of thin-cap fibroatheroma (TCFA), plaque disruption, and macrophage accumulation in non-culprit lesions (Figure). In addition, non-culprit plaques in the RP group showed higher lipid index (1196.9±700.5 vs. 747.7±377.3, p=0.001) and thinner fibrous cap (107.0±56.5 μm vs. 137.3±69.8 μm, p=0.035). In the RP group, the additional disruptions were more frequently located in the infarct-related artery than in non infarct-related arteries (52.9% vs. 7.3%, p<0.001).
Conclusions: Patients with ACS and ruptured culprit plaque have increased pancoronary vulnerability compared to those with non-ruptured culprit plaque. Our results suggest that a more aggressive treatment paradigm aiming at the stabilization of vulnerable plaques may offer additional benefit to these patients.
- © 2013 by American Heart Association, Inc.