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Randomized Controlled Trial
. 2017 Feb 24;6(3):e004730.
doi: 10.1161/JAHA.116.004730.

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Sining Hu  1   2 , Yinchun Zhu  1   2 , Yingying Zhang  1   2 , Jiannan Dai  3 , Lulu Li  1   2 , Harold Dauerman  4 , Tsunenari Soeda  5 , Zhao Wang  6 , Hang Lee  7 , Chao Wang  1   2 , Chunyang Zhe  1   2 , Yan Wang  1   2 , Gonghui Zheng  1   2 , Shaosong Zhang  1   2 , Haibo Jia  8   2 , Bo Yu  8   2 , Ik-Kyung Jang  9
Affiliations
Randomized Controlled Trial

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Sining Hu et al. J Am Heart Assoc. .

Abstract

Background: Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied.

Methods and results: We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%, P<0.001), thrombus (59.4% versus 14.6%, P<0.001), and protrusion (93.8% versus 73.2%, P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1-year follow-up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events.

Conclusions: Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.

Keywords: acute coronary syndrome; optical coherence tomography; plaque erosion; plaque rupture.

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Figures

Figure 1
Figure 1
Study flow chart. ACS indicates acute coronary syndrome; CABG, coronary artery bypass grafting; OCT, optical coherence tomography; PR, plaque rupture.
Figure 2
Figure 2
Representative optical coherence tomography (OCT) images of plaque erosion. A 28‐year‐old man with ST‐segment elevation myocardial infarction was admitted after 2 hours of chest pain. Results from index angiogram showed total occlusion in the mid–left anterior descending artery (LAD; white arrow, A). Angiogram results after thrombus aspiration showed a mild stenosis in the mid‐LAD (B). Cross‐sectional image of the culprit lesion shows residual white thrombus without evidence of ruptured fibrous cap (yellow arrows, C). The patient was treated with medical therapy without stent implantation.
Figure 3
Figure 3
Representative optical coherence tomography (OCT) images of plaque rupture. A 60‐year‐old woman with ST‐segment elevation myocardial infarction was admitted after 11 hours of chest pain. Results from diagnostic angiogram showed total occlusion in the proximal left anterior descending artery (LAD). Angiogram results after thrombectomy demonstrates dissection lesion in the proximal LAD (white arrow, left upper panel). Cross‐sectional OCT images of the culprit lesion show disrupted fibrous cap (white arrows) and cavity (asterisk) formation (A through C). The patient was treated with a drug‐eluting stent (3.0×18 mm). Poststenting OCT revealed in‐stent thrombus (red arrows, D), malapposed struts (white arrows, E), and stent protrusion (yellow arrows, F).
See this image and copyright information in PMC

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