Key result
Plaque rupture dominates both STEMI and NSTEMI, while erosion accounts for ~34% of STEMI culprits.
Why the study?
Patients with STEMI are postulated to have different culprit lesion morphology compared to NSTEMI, and OCT can help delineate lesion morphology in ACS.
Does optical coherence tomography (OCT) identify differences in culprit lesion morphology between STEMI and NSTEMI in patients with acute coronary syndrome?
Systematic Review (n=7,526)
Does optical coherence tomography (OCT) identify differences in culprit lesion morphology between STEMI and NSTEMI in patients with acute coronary syndrome?
In patients with ACS, plaque rupture is the predominant culprit lesion morphology on OCT in both STEMI and NSTEMI, though STEMI is associated with higher rates of rupture, erosion, and high-risk plaque features.
OCT refines ACS culprit assessment; extends morphological data distinguishing STEMI from NSTEMI erosion rates.
Background: Patients with STEMI are postulated to have different culprit lesion morphology compared to NSTEMI. The use of OCT in ACS can help delineate lesion morphology. The aim of this systematic review was to analyze the available data on culprit plaque morphology in ACS patients. Methods: The available literature was systematically screened for studies on culprit lesion morphology in ACS patients. Data was extracted from the selected studies and analyzed for baseline characteristics as well as culprit lesion morphology on OCT. Lesion characteristics between STEMI and NSTEMI groups were compared. Results: A total of 32 studies were selected for the final analysis. The average age of the study population was 62.4 years. Majority of patients (66.6%) had STEMI on presentation. NSTEMI patients had a higher prevalence of diabetes compared to STEMI. Both STEMI and NSTEMI patients had similar prevalence of thin-cap fibroatheroma (44.9%). The mean fibrous cap thickness was 84.2 μm in the study. STEMI patients had higher prevalence of lipid plaques, macrophages and luminal thrombus as compared to NSTEMI patients. Plaque rupture was the predominant culprit lesion morphology in both STEMI and NSTEMI groups, with higher prevalence in STEMI patients. Plaque erosion was also more common in STEMI patients (34.4% vs 13.2%). Conclusion: Plaque rupture is the predominat culprit lesion morphology in both STEMI and NSTEMI patients, despite having differences in baseline characteristics. Use of OCT to determine plaque morphology in ACS patients can help guide management strategy in select cases. [PROSPERO CRD42021249742].
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Mani et al. (2023) conducted a systematic review in Acute Coronary Syndrome (STEMI vs NSTEMI) (n=7,526). STEMI vs. NSTEMI was evaluated on Plaque erosion. Plaque rupture was the predominant culprit lesion morphology in both STEMI and NSTEMI patients, though plaque erosion was more common in STEMI compared to NSTEMI (34.4% vs 13.2%).
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