Key result
OCT identified three prominent morphological plaque patterns in ACS: intimal discontinuity (50%), significant stenosis with vulnerability features (27.1%), and protrusive calcified nodule (22.9%).
Why the study?
OCT is an ideal imaging technique to assess culprit coronary plaque anatomy, prompting investigation into morphological features and mechanisms leading to plaque complication in ACS.
Observational (n=70)
No
OCT imaging in ACS patients reveals three distinct morphological patterns of complicated coronary plaques: intimal discontinuity, vulnerable plaques with significant stenosis, and protrusive calcified nodules.
OCT plaque features in ACS should not guide therapy yet; leaves open mechanistic validation in prospective cohorts.
Optical coherence tomography (OCT) is an ideal imaging technique for assessing culprit coronary plaque anatomy. We investigated the morphological features and mechanisms leading to plaque complication in a single-center observational retrospective study on 70 consecutive patients with an established diagnosis of acute coronary syndrome (ACS) who underwent OCT imaging after coronary angiography. Three prominent morphological entities were identified. Type I or intimal discontinuity, which was found to be the most common mechanism leading to ACS and was seen in 35 patients (50%), was associated with thrombus (68.6%; p = 0.001), mostly affected the proximal plaque segment (60%; p = 0.009), and had no distinctive underlying plaque features. Type II, a significant stenosis with vulnerability features (inflammation in 16 patients, 84.2%; thin-cap fibroatheroma (TCFA) in 10 patients, 52.6%) and a strong association with lipid-rich plaques (94.7%; p = 0.002), was observed in 19 patients (27.1%). Type III, a protrusive calcified nodule, which was found to be the dominant morphological pattern in 16 patients (22.9%), was found in longer plaques (20.8 mm vs. 16.8 mm ID vs. 12.4 mm SS; p = 0.04) and correlated well with TCFA (93.8%; p = 0.02) and inflammation (81.3%). These results emphasize the existence of a wide spectrum of coronary morphological patterns related to ACS.
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Onea et al. (2022) conducted an observational in Acute coronary syndrome (ACS) (n=70). Morphological patterns of complicated coronary plaques was evaluated on Morphological features and mechanisms leading to plaque complication. OCT identified three prominent morphological plaque patterns in ACS: intimal discontinuity (50%), significant stenosis with vulnerability features (27.1%), and protrusive calcified nodule (22.9%).
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