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J Am Heart Assoc. 2019 Nov 5;8(21):e012322. doi: 10.1161/JAHA.119.012322. Epub 2019 Oct 23.

Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes.

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Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.
Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan.
Departmant of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan.
Department of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki Japan.
Department of Cardiovascular Medicine Nara Medical University Kashihara Nara Japan.
Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong.
Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan.
Department of Cardiovascular and Thoracic Science Catholic University of the Sacred Heart Fondazione Policlinico Agostino Gemelli - IRCCS Rome Italy.
Department of Cardiology Hirosaki University Graduate School of Medicine Hirosaki Aomori Japan.
Division of Cardiology Kameda Medical Center Kamogawa Chiba Japan.
Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Kanagawa Japan.
Department of Cardiovascular Medicine University Hospitals Leuven Leuven Belgium.
Department of Cardiology University of Giessen Germany.
Biostatiscs Center Massachusetts General Hospital Harvard Medical School Boston MA.
Research Laboratory of Electronics Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology Cambridge MA.
Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.
Division of Cardiology Kyung Hee University Hospital Seoul Republic of Korea.


Background Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti-thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non-ST-segment elevation-ACS than in ST-segment-elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age <68 years, anterior ischemia, no diabetes mellitus, hemoglobin >15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non-ST-segment elevation-ACS, the probability of plaque erosion increased to 73.1%. Conclusions Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of ACS patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies. Clinical Trial Registration URL: Unique identifier: NCT03479723.


acute coronary syndrome; optical coherence tomography; plaque erosion

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