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EuroIntervention. 2019 Apr 2. pii: EIJ-D-18-01175. doi: 10.4244/EIJ-D-18-01175. [Epub ahead of print]

Characteristics and Significance of Healed Plaques in Patients with Acute Coronary Syndrome and Stable Angina: An In Vivo OCT and IVUS Study.

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1
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.

Abstract

AIMS:

To determine the prevalence and significance of plaque with a multilayered (ML) pattern in patients with acute coronary syndrome (ACS) vs stable angina pectoris (SAP) using OCT.

METHODS AND RESULTS:

204 patients (144 ACS and 60 SAP) with OCT imaging of the culprit lesions before intervention were studied. ML plaques were identified by OCT as a plaque with multiple layers of distinct optical signals. ML plaque was identified in 119 out of 204 (58.3%) patients. ML plaques were more frequently observed in SAP than ACS (75% vs. 51.4%, p=0.001). Patients with prior myocardial infarction (MI) had higher incidence of ML plaque compare with those without (74.4% vs. 54.5%, p=0.024). ML plaque had a higher degree of luminal stenosis (p=0.006), longer lesion length (p=0.025), more complex lesion type (B2/C) (p<0.001) on angiogram and non-significant larger plaque burden (p=0.07) on IVUS compared with those without ML pattern.

CONCLUSIONS:

ML plaques, indicative of prior thrombosis, were frequently identified in patients with CAD, particularly higher in SAP and those with prior MI compared with ACS. The presence of ML pattern is a marker of greater extent and severity of CAD, suggesting a pathogenic link between plaque healing and lesion progression.

PMID:
30946013
DOI:
10.4244/EIJ-D-18-01175
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