Author + information
- Received September 30, 2018
- Revision received November 26, 2018
- Accepted December 12, 2018
- Published online March 18, 2019.
- Tomoyo Sugiyama, MD, PhDa,
- Erika Yamamoto, MD, PhDa,
- Francesco Fracassi, MDa,
- Hang Lee, PhDb,
- Taishi Yonetsu, MDc,∗∗ (, )
- Tsunekazu Kakuta, MD, PhDd,
- Tsunenari Soeda, MD, PhDe,
- Yoshihiko Saito, MD, PhDe,
- Bryan P. Yan, MBBSf,
- Osamu Kurihara, MD, PhDg,
- Masamichi Takano, MD, PhDg,
- Giampaolo Niccoli, MD, PhDh,
- Filippo Crea, MDh,
- Takumi Higuma, MD, PhDi,
- Shigeki Kimura, MD, PhDj,
- Yoshiyasu Minami, MD, PhDk,
- Junya Ako, MD, PhDk,
- Tom Adriaenssens, MD, PhDl,
- Niklas F. Boeder, MDm,
- Holger M. Nef, MDm,
- James G. Fujimoto, PhDn,
- Valentin Fuster, MD, PhDo,
- Aloke V. Finn, MDp,
- Erling Falk, MD, DMScq and
- Ik-Kyung Jang, MD, PhDa,r,∗ ()
- aCardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bBiostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cDepartment of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
- dDepartment of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
- eDepartment of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
- fDepartment of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
- gCardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
- hDepartment of Cardiovascular and Thoracic Science, Catholic University of the Sacred Heart, Rome, Italy
- iDepartment of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- jDepartment of Cardiology, Kameda Medical Center, Kamogawa, Japan
- kDepartment of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- lDepartment of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- mDepartment of Cardiology, University of Giessen, Giessen, Germany
- nResearch Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- oZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- pCVPath Institute, Gaithersburg, Maryland
- qDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- rDivision of Cardiology, Kyung Hee University Hospital, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Ik-Kyung Jang, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, Massachusetts 02114.
- ↵∗∗Dr. Taishi Yonetsu, Department of Interventional Cardiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo Ward, Tokyo 113-8519, Japan.
Objectives This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS).
Background Calcified plaques as an underlying pathology in patients with ACS have not been systematically studied.
Methods From 1,241 patients presenting with ACS who had undergone pre-intervention optical coherence tomography imaging, 157 (12.7%) patients were found to have a calcified plaque at the culprit lesion. Calcified plaque was defined as a plaque with superficial calcification at the culprit site without evidence of ruptured lipid plaque.
Results Three distinct types were identified: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion (prevalence of 25.5%, 67.4%, and 7.1%, respectively). Eruptive calcified nodules were frequently located in the right coronary arteries (44.4%), whereas superficial calcific sheet was most frequently found in the left anterior descending coronary arteries (68.4%) (p = 0.012). Calcification index (mean calcification arc × calcification length) was greatest in eruptive calcified nodules, followed by superficial calcific sheet, and smallest in calcified protrusion (median 3,284.9 [interquartile range (IQR): 2,113.3 to 5,385.3] vs. 1,644.3 [IQR: 1,012.4 to 3,058.7] vs. 472.5 [IQR: 176.7 to 865.2]; p < 0.001). The superficial calcific sheet group had the highest peak post-intervention creatine kinase values among the groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 241 [IQR: 116 to 612] IU/l vs. 834 [IQR: 141 to 3,394] IU/l vs. 745 [IQR: 69 to 1,984] IU/l; p = 0.032).
Conclusions Three distinct types of calcified culprit plaques are identified in patients with ACS. Superficial calcific sheet, which is frequently located in the left anterior descending coronary artery, is the most prevalent type and is also associated with greatest post-intervention myocardial damage. (Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome; NCT03479723)
Dr. Sugiyama is supported in part by the grant from the Strategic International Research Collaboration Program with Harvard Medical School to Cultivate Professionals with Knowledge and Humanity from the Japan Society for the Promotion of Science, and the subvention from Sumitomo Life Welfare and Culture Foundation. Dr. Saito has received personal fees from Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical, Daiichi Sankyo, Pfizer Japan, Nippon Boehringer Ingelheim, and Novartis Pharma; and has received research support from Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical, Daiichi Sankyo, Pfizer Japan, Nippon Boehringer Ingelheim, Novartis Pharma, Ono Pharmaceutical, St. Jude Medical Japan, Bayer, Terumo, Kyowa Hakko Kirin, and Dainippon Sumitomo Pharma. Dr. Ako has received speaker honoraria from Abbott Vascular. Dr. Adriaenssens has received educational grants and consulting fees from Abbott Vascular. Dr. Fujimoto has received royalties from intellectual property owned by Massachusetts Institute of Technology. Dr. Finn has received honoraria and research grant support from Abbott Vascular. Dr. Jang has received grant support from Abbott Vascular and Medicure; and consulting fees from Lycotec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 30, 2018.
- Revision received November 26, 2018.
- Accepted December 12, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.