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Arterioscler Thromb Vasc Biol. 2016 Nov;36(11):2229-2238. Epub 2016 Sep 15.

Prevalence and Predictors of Multiple Coronary Plaque Ruptures: In Vivo 3-Vessel Optical Coherence Tomography Imaging Study.

Author information

1
From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
2
From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.). ijang@mgh.harvard.edu yubodr@163.com.

Abstract

OBJECTIVE:

Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures.

APPROACH AND RESULTS:

Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039).

CONCLUSIONS:

Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.

KEYWORDS:

atherosclerosis; fibroatheroma; incidence; optical coherence tomography; phenotype

PMID:
27634834
DOI:
10.1161/ATVBAHA.116.307891
[Indexed for MEDLINE]

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