Culprit lesion morphology in patients with ST-segment elevation myocardial infarction assessed by optical coherence tomography.
Age Factors
Coronary Angiography
/ methods
Coronary Vessels
/ diagnostic imaging
Denmark
/ epidemiology
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
/ methods
Plaque, Atherosclerotic
/ diagnostic imaging
Preoperative Care
/ methods
Risk Factors
Rupture, Spontaneous
ST Elevation Myocardial Infarction
/ diagnosis
Severity of Illness Index
Smoking
/ epidemiology
Tomography, Optical Coherence
/ methods
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
2
9
2020
medline:
12
10
2021
entrez:
2
9
2020
Statut:
ppublish
Résumé
This study sought to evaluate the incidence of ruptured plaques and nonruptured plaques (NRP) and to compare patient characteristics and detailed plaque morphology features between the two culprit types in ST-segment elevation myocardial infarction (STEMI) patients, using optical coherence tomography (OCT). Using OCT, the culprit lesions in patients with STEMI were assessed prior to stent implantation. The culprit lesion was categorized as ruptured plaques or NRP, and the plaque components were evaluated. Fifty-two patients (69.3%) presented with ruptured plaques and 23 (30.7%) with NRP. Patients with NRP were younger (58.0 ± 10.4 vs 64.7 ± 9.9 years, P = 0.01) and more often smokers (72.7% vs 37.1%, P = 0.001), compared to ruptured plaques. NRP contained significantly more fibrotic plaque (20.0% [interquartile range (IQR) 13.7-29.8] vs 11.3% [IQR 6.9-18.1], P = 0.005), but less lipidic plaque (44.0% ± 13.7 vs 59.3% ± 13.6, P < 0.001), less superficial [5.0% (IQR 2.8-7.5) vs 8.1% (IQR 5.7-11.0), P = 0.005] and profound macrophages [0.9% (IQR 0.0-1.7) vs 2.2% (IQR 0.9-4.7), P = 0.003]. The prevalence, numbers and lengths of thin-cap fibroatheroma (TCFA) were significantly lower in NRP, compared to ruptured plaques [47.8% vs 88.5%, 0 (IQR 0-1) vs 1 (IQR 1-2) and 0 mm (IQR 0-2.7) vs 4.5 mm (IQR 2.3-7.7), P < 0.001]. One-third of STEMI patients had culprit lesions without an OCT-detectable ruptured plaque. Culprit lesions with NRP contained less vulnerable plaque components, such as lipid plaque, TCFAs and macrophages compared to ruptured plaques.
Identifiants
pubmed: 32868663
doi: 10.1097/MCA.0000000000000957
pii: 00019501-202012000-00002
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
671-677Références
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