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Multicenter Study
. 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

Erika Yamamoto  1   2 , Taishi Yonetsu  3 , Tsunekazu Kakuta  4 , Tsunenari Soeda  5 , Yoshihiko Saito  5 , Bryan P Yan  6 , Osamu Kurihara  7 , Masamichi Takano  7 , Giampaolo Niccoli  8 , Takumi Higuma  9 , Shigeki Kimura  10 , Yoshiyasu Minami  11 , Junya Ako  11 , Tom Adriaenssens  12 , Niklas F Boeder  13 , Holger M Nef  13 , Francesco Fracassi  1 , Tomoyo Sugiyama  1 , Hang Lee  14 , Filippo Crea  8 , Takeshi Kimura  2 , James G Fujimoto  15 , Valentin Fuster  16 , Ik-Kyung Jang  1   17
Affiliations
Multicenter Study

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

Erika Yamamoto et al. J Am Heart Assoc. .

Abstract

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: http://www.clinicaltrials.gov. Unique identifier: NCT03479723.

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

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Figures

Figure 1
Figure 1
Optical coherence tomography images of 3 plaque pathologies. A, Plaque rupture was defined by the presence of fibrous cap discontinuity with a communication between the lumen and the inner core of a plaque or with a cavity formation within the plaque. B, Plaque erosion was defined as a culprit plaque with an intact fibrous cap with or without attached thrombus. C, Calcified plaque was defined by the presence of superficial substantive calcium at the culprit site without evidence of ruptured lipid plaque. Others include spontaneous coronary artery dissection, microvascular disease, spasm, Takotsubo cardiomyopathy, myocardial infarction with non‐obstructive coronary arteries, etc. MINOCA indicates myocardial infarction with non‐obstructive coronary arteries; SCAD, spontaneous coronary artery dissection.
Figure 2
Figure 2
Prevalence of plaque rupture, erosion, and calcified plaque in ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation acute coronary syndrome. Among 1241 patients, 648 presented with ST‐segment–elevation myocardial infarction and 593 with non–ST‐segment–elevation acute coronary syndrome. The prevalence of plaque rupture, plaque erosion, and calcified plaque was 59.4%, 29.8%, and 10.8% in ST‐segment–elevation myocardial infarction; 37.4%, 47.9%, and 14.7% in non–ST‐segment–elevation acute coronary syndrome. The prevalence of plaque erosion was significantly higher in non–ST‐segment–elevation acute coronary syndrome than in ST‐segment–elevation myocardial infarction patients (47.9% vs 29.8%, P=0.0002). NSTE‐ACS indicates non–ST‐segment–elevation acute coronary syndrome; STEMI, ST‐segment–elevation myocardial infarction.
Figure 3
Figure 3
Probability of plaque erosion. When all 5 parameters are present in a patient with non–ST‐segment–elevation acute coronary syndrome, the probability of plaque erosion increased to 73.1%. When a patient with non–ST‐segment–elevation acute coronary syndrome has all 5 parameters, the odd ratio increases to 3.40. DM indicates diabetes mellitus.
Figure 4
Figure 4
Pathogenesis of plaque erosion. Plaque erosion might be the result of a combination of several “non‐traditional” factors; endothelial factors, vasomotion factors, fluid dynamics factors, and systemic factors. ACS indicates acute coronary syndromes; LAD, left anterior descending artery; NETs, neutrophil extracellular traps.
See this image and copyright information in PMC

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