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Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome.
- Source :
-
European heart journal [Eur Heart J] 2015 Jun 07; Vol. 36 (22), pp. 1377-84. Date of Electronic Publication: 2015 Feb 18. - Publication Year :
- 2015
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Abstract
- Aims: Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS.<br />Methods and Results: We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis was assessed according to such culprit lesion classification. Major adverse cardiac events (MACEs) were defined as the composite of cardiac death, non-fatal myocardial infarction, unstable angina, and target lesion revascularization (follow-up mean time 31.58 ± 4.69 months). The study comprised 139 consecutive ACS patients (mean age 64.3 ± 12.0 years, male 73.4%, 92 patients with non-ST elevation ACS and 47 with ST-elevation ACS). Plaque rupture was detected in 82/139 (59%) patients. There were no differences in clinical, angiographic, or procedural data between patients with PR when compared with those having IFC. Major adverse cardiac events occurred more frequently in patients with PR when compared with those having IFC (39.0 vs. 14.0%, P = 0.001). Plaque rupture was an independent predictor of outcome at multivariable analysis (odds ratio 3.735, confidence interval 1.358-9.735).<br />Conclusion: Patients with ACS presenting with PR as culprit lesion by OCT have a worse prognosis compared with that of patients with IFC. This finding should be taken into account in risk stratification and management of patients with ACS.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
- Subjects :
- Acute Coronary Syndrome mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Plaque, Atherosclerotic mortality
Prospective Studies
Risk Factors
Rupture, Spontaneous mortality
Rupture, Spontaneous pathology
Tomography, Optical Coherence
Treatment Outcome
Acute Coronary Syndrome pathology
Plaque, Atherosclerotic pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1522-9645
- Volume :
- 36
- Issue :
- 22
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 25713314
- Full Text :
- https://doi.org/10.1093/eurheartj/ehv029