Association between Eicosapentaenoic Acid to Arachidonic Acid Ratio and Characteristics of Plaque Rupture

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute coronary syndrome caused by plaque rupture (n=95). Intervention: High EPA/AA ratio (≥0.41) vs. Low EPA/AA ratio (<0.41). Primary outcome: Development of layered plaques (OR 5.98, 95% CI 2.04-17.51, p=<0.01).

Teruo Sekimoto; Shinji Koba; Hiroyoshi Mori; Taito Arai; Myong Hwa Yamamoto; Takuya Mizukami; Naoki Matsukawa; Rikuo Sakai; Yuya Yokota; Shunya Sato; Hideaki Tanaka; Ryota Masaki; Yosuke Oishi; Kunihiro Ogura; Ken Arai; Kosuke Nomura; Koshiro Sakai; Hiroaki Tsujita; Seita Kondo; Shigeto Tsukamoto; Hiroshi Suzuki; Toshiro Shinke

doi:10.5551/jat.63806

Key result

A high EPA/AA ratio (≥0.41) was independently associated with a higher prevalence of layered plaques (OR 5.98) and calcified plaques (OR 3.15) in patients with acute coronary syndrome caused by plaque rupture.

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Why the study?

EPA stabilizes coronary plaques, but its association with healed plaques, thrombus size, and plaque rupture characteristics remained unclarified.

Does a high EPA/AA ratio associate with the development of layered and calcified plaques in patients with acute coronary syndrome caused by plaque rupture?

Study Design

Type

Cross-Sectional (n=95)

Multicenter

No

Structured PICO

Does a high EPA/AA ratio associate with the development of layered and calcified plaques in patients with acute coronary syndrome caused by plaque rupture?

P

Population

95 patients with acute coronary syndrome caused by plaque rupture, not taking lipid-lowering drugs, who underwent percutaneous coronary intervention using optical coherence tomography.

E

Exposure

High EPA/AA ratio (≥0.41) based on serum levels

C

Comparator

Low EPA/AA ratio (<0.41) based on serum levels

O

Outcome

Prevalence of layered and calcified plaques assessed by optical coherence tomography (OCT)surrogate

Main Result

Odds Ratio: 5.98 (95% CI 2.04–17.51)

Absolute Event Rate: 75.9% vs 39.4%

p-value: p=<0.01

A high EPA/AA ratio is independently associated with the presence of layered and calcified plaques in patients with ACS caused by plaque rupture, suggesting a potential role of EPA in plaque stabilization and healing.

Limitations

Single-center study with a relatively small sample size
Analysis of lipid markers and plaques at the onset of ACS may not be sufficient to elucidate the full impact of plaques on EPA
Patients in the high EPA/AA group were significantly older
Thrombectomy procedure might modify the culprit lesion morphology, and residual thrombus might affect analysis
Resolution and penetration depth of OCT imaging are inadequate for accurate detection of plaque ruptures
Iatrogenic luminal injuries caused by intracoronary thrombectomy may have been incorrectly identified as plaque ruptures
Difficult to distinguish thin-cap fibroatheromas from ruptured plaques with a thin-fibrous cap by OCT
Did not measure EPA levels as a percentage of total fatty acids
Selection bias due to only including patients who underwent OCT-guided percutaneous coronary intervention

Implication

High EPA/AA ratio associated with layered/calcified plaques in ACS rupture; hypothesis-generating for stabilization, needs prospective confirmation before practice implications.

Abstract

AIMS: Eicosapentaenoic acid (EPA) has shown beneficial effects on coronary plaque stabilization. Based on our previous study, we speculated that EPA might be associated with the development of healed plaques and might limit thrombus size. This study aimed to elucidate the association between EPA and arachidonic acid (AA) ratios and various plaque characteristics in patients with plaque rupture. METHODS: A total of 95 patients with acute coronary syndrome (ACS) caused by plaque rupture who did not take lipid-lowering drugs and underwent percutaneous coronary intervention using optical coherence tomography (OCT) were included. Clinical characteristics, lipid profiles, and OCT findings were compared between patients with lower and higher EPA/AA ratios (0.41) according to the levels in the Japanese general population. RESULTS: In the high EPA/AA (n=29, 30.5%) and low EPA/AA (n=66, 69.5 %) groups, the high EPA/AA group was significantly older (76.1 vs. 66.1 years, P＜0.01) and had lower peak creatine kinase (556 vs. 1651 U/L, P=0.03) than those with low EPA/AA. Similarly, patients with high EPA/AA had higher prevalence of layered and calcified plaque (75.9 vs. 39.4 %, P＜0.01; 79.3 vs. 50.0 %, P＜0.01, respectively) than low EPA/AA group. Multivariate logistic regression analysis demonstrated that a high EPA/AA ratio was an independent factor in determining the development of layered and calcified plaques. CONCLUSION: A high EPA/AA ratio may be associated with the development of layered and calcified plaques in patients with plaque rupture.

Discussion

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Cite This Study

Sekimoto et al. (2023) conducted a cross-sectional in Acute coronary syndrome caused by plaque rupture (n=95). High EPA/AA ratio (≥0.41) vs. Low EPA/AA ratio (<0.41) was evaluated on Development of layered plaques (OR 5.98, 95% CI 2.04-17.51, p=<0.01). A high EPA/AA ratio (≥0.41) was independently associated with a higher prevalence of layered plaques (OR 5.98) and calcified plaques (OR 3.15) in patients with acute coronary syndrome caused by plaque rupture.

synapsesocial.com/papers/6a2207e8c7675eb28596f215 https://doi.org/10.5551/jat.63806

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Association between Eicosapentaenoic Acid to Arachidonic Acid Ratio and Characteristics of Plaque Rupture

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between Eicosapentaenoic Acid to Arachidonic Acid Ratio and Characteristics of Plaque Rupture

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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