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



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.


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.


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.

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