Prevalence, Morphology, and Predictors of Intra-Stent Plaque Rupture in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Coronary Syndrome with late or very late stent failure (n=213). Intervention: In-stent plaque rupture (PR) vs. Non-plaque rupture (Non-PR). Primary outcome: Occurrence of in-stent plaque rupture associated with previous history of myocardial infarction (OR 3.583, 95% CI 1.493-8.599, p=0.004).

Huai Yu; Jiannan Dai; Chao Fang; Senqing Jiang; Gary S. Mintz; Bo Yu

doi:10.1177/10760296221146742

January 1, 2022Clinical and Applied Thrombosis/HemostasisOpen Access

Prevalence, Morphology, and Predictors of Intra-Stent Plaque Rupture in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

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Key result

Prior MI linked to ~3.6-fold higher risk of in-stent plaque rupture in ACS patients.

OR 3.583
95% CI 1.493-8.599
P=0.004
n=213

Figures

Why the study?

What are the prevalence, morphological characteristics, and predictors of intra-stent plaque rupture in patients with ACS presenting with late stent failure?

Study Design

Type

Observational (n=213)

Multicenter

No

Structured PICO

What are the prevalence, morphological characteristics, and predictors of intra-stent plaque rupture in patients with ACS presenting with late stent failure?

P

Population

213 patients with acute coronary syndrome (ACS) and late/very late (>30 days from implantation) symptomatic drug-eluting stent (DES) failure, age >20 years, with sufficient OCT images obtained at the time of stent failure. Exclusions: angiographically left main disease, CABG, congestive heart failure or cardiogenic shock, renal insufficiency (creatinine >1.5 mg/dL), poor OCT image quality, or secondary plaque rupture caused by thrombectomy/predilatation.

I

Intervention

Presence of in-stent plaque rupture (PR) identified by optical coherence tomography (OCT) (n=80)

C

Comparator

Absence of in-stent plaque rupture (non-PR) identified by optical coherence tomography (OCT) (n=133)

O

Outcome

Prevalence, morphology (OCT findings), and predictors of in-stent plaque rupturesurrogate

Main Result

Effect estimate: OR 3.583 (95% CI 1.493-8.599)

p-value: p=0.004

Limitations

Included several different drug-eluting stents
Clinical presentations and underlying lesion morphology were unavailable at the time of the original stent implantation
Manual thrombectomy or pre-dilatation with small-sized balloons was performed in a considerable number of patients, which might affect underlying morphology
Presence of a massive thrombus might reduce the ability of OCT to recognize the underlying plaque characteristics
Included several different DESs, and clinical presentations and underlying lesion morphology were unavailable at the time of the original stent implantation
Manual thrombectomy or pre-dilatation with small-sized balloons was performed in a considerable number of patients, which might affect the underlying morphology of atherosclerotic lesions

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Cite This Study

Yu et al. (2022) conducted an observational in Acute Coronary Syndrome with late or very late stent failure (n=213). In-stent plaque rupture (PR) vs. Non-plaque rupture (Non-PR) was evaluated on Occurrence of in-stent plaque rupture associated with previous history of myocardial infarction (OR 3.583, 95% CI 1.493-8.599, p=0.004). Previous history of myocardial infarction and longer lipidic neointima length were associated with a 3.6-fold and 1.3-fold higher risk for the occurrence of in-stent plaque rupture in ACS patients.

synapsesocial.com/papers/6a08819c113ba5b476de3a24 https://doi.org/10.1177/10760296221146742

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Prevalence, Morphology, and Predictors of Intra-Stent Plaque Rupture in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Abstract

Discussion

Cite This Study

Prevalence, Morphology, and Predictors of Intra-Stent Plaque Rupture in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Abstract

Discussion

Cite This Study

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