Relationship between cholesterol crystals and culprit lesion characteristics in patients with stable coronary artery disease: an optical coherence tomography study

Abstract

Aims: Some recent studies have reported the role of cholesterol crystals (ChCs) in plaque rupture in patients with coronary artery disease. We used optical coherence tomography (OCT) to investigate the characteristics of coronary plaques that were associated with derived ChCs.

Methods: We evaluated 101 subjects with stable coronary artery disease who underwent OCT. We compared the OCT findings of the culprit lesions with ChCs to those without ChCs and investigated the background characteristics.

Results: ChCs were observed in culprit lesions of 39 patients. The frequencies of spotty calcification, microchannel structure, and lipid-rich plaque were significantly higher in patients with ChCs than those without ChCs (64.1 vs. 27.4%, p < 0.001; 69.2 vs. 38.7%, p = 0.003; 53.8 vs. 29.0%, p = 0.01, respectively). On the other hand, the frequencies of thrombus, disruption, and thin-cap fibroatheroma did not differ significantly between patients with and without ChCs (15.3 vs. 24.1%, p = 0.3; 33.3 vs. 17.7%, p = 0.07; and 33.3 vs. 24.1 %, p = 0.3, respectively). Among the possible clinical factors, multivariate analysis showed an elevated level of glycated hemoglobin as the sole significant factor associated with ChCs.

Conclusion: ChCs are frequently associated with the major findings of vulnerable plaque, and are often seen in poorly controlled diabetic patients. Thus, ChCs might be one of the features of vulnerable plaque.