Author + information
- Sang Wook Kim1,
- Hoyoun Won1,
- Gary S. Mintz2,
- Neil J. Weissman3,
- Young Joon Hong4,
- Sung Yun Lee5,
- Ki Seok Kim6,
- Joo Yong Hahn7,
- Seung Ho Kang8,
- Wang Soo Lee1,
- Seong Hyeop Hyeon1,
- Jee Eun Kwon1,
- Seung Yong Shin1,
- Kwang Je Lee1,
- Tae Ho Kim1 and
- Chee Jeong Kim1
We used optical coherent tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS) to assess culprit lesions in 133 patients with acute coronary syndrome (ACS).
Culprit lesion plaque rupture (PR, n=90) or plaque erosion (PE, n=43) was diagnosed with OCT; and IVUS was used to determine arterial remodeling. Plaque Erosion was defined as the presence of intracoronary thrombus attached to the luminal surface with no detectable signs of fibrous cap rupture. Positive remodeling was a remodeling index (lesion/reference EEM [external elastic membrane] area) >1.05.
Overall, 26% (11/43) of PE had non-ST elevation myocardial infarction (NSTEMI) and 35% (15/43) had STEMI; conversely, 14.4% (13/90) of PR had NSTEMI and 71% (64/90) had STEMI (p<0.0001). PR more often showed positive remodeling with a larger necrotic core area by VH-IVUS(p<0.0001), however PE showed prominent negative remodeling(58.1%, p=0.003). By OCT, PE were fibrotic in 60% (26/43), fibrocalcific in 16% (7/43), lipidic in 23.2% (10/43, all but five of which was a thick cap fibroatheroma). Overall, 65% of plaque erosions (28 of 43) were located in the proximal 30mm of a culprit vessel - similar to plaque ruptures (72%, 65 of 90, p=0.29).
Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.
|Lesion length (mm)||18.49±7.53||14.89±5.55||0.003|
|Distal reference lumen area (mm2)||7.54±3.2||7.17±2.82||0.53|
|Minimal lumen area (mm2)||3.2±1.69||4.2±3.05||0.018|
|Rupture vs erosion sites|
|lumen area (mm2)||6.08±2.85||7.02±3.29||0.11|
|Plaque area (mm2)||11.61±4.6||7.29±3.38||<0.0001|
|Plaque burden (%)||65.08±12.15||50.5±16.63||<0.0001|
|%Necrotic core area||24.74±11.07||15.06±12.47||<0.0001|