Clinical Significance of the Presence or Absence of Lipid‐Rich Plaque Underneath Intact Fibrous Cap Plaque in Acute Coronary Syndrome

Figures

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  Figure 1. Study flow diagram illustrates the process of selecting patients for inclusion from the institutional database of intravascular optical coherence tomography (OCT) performed at Tsuchiura Kyodo General Hospital (Ibaraki, Japan) between November 2008 and May 2017. ACS indicates acute coronary syndrome; IFC, intact fibrous cap; LRP, lipid‐rich plaque; PCI, percutaneous coronary intervention.

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  Figure 2. Representative optical coherence tomography (OCT) images of 3 types of culprit plaque morphological characteristics in patients with acute coronary syndrome (ACS). Representative OCT images of ACS. A, Lesions with plaque rupture; cross‐sectional image shows rupture of fibrous cap and a cavity formation in the lipid core. B, Lesions with intact fibrous cap (IFC)–lipid‐rich plaque (LRP); LRP and thrombus without disruption of fibrous cap. C, Lesions with IFC–non‐LRP; fibrous plaque and thrombus without disruption of fibrous cap.

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  Figure 3. Kaplan‐Meier curves showing major adverse cardiac event (MACE)–free survival, according to the culprit plaque morphological characteristics. A, The incidence of MACEs was significantly higher in patients with plaque rupture (PR) than in those with intact fibrous cap (IFC). Compared with patients with PR, the adjusted hazard ratio (HR) of those with IFC was generated from multivariate Cox proportional hazards model, including estimated glomerular filtration rate (eGFR), prior myocardial infarction (MI), second‐generation drug‐eluting stent (DES), and American Heart Association/American College of Cardiology (AHA/ACC) classification B2/C. B, The incidence of MACEs was significantly higher in patients with lipid‐rich plaque (LRP) than in those without LRP. Compared with patients with LRP, the adjusted HR of those without LRP was generated from multivariate Cox proportional hazards model, including eGFR, prior MI, second‐generation DES, and AHA/ACC classification B2/C.

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  Figure 4. Kaplan‐Meier curves showing major adverse cardiac event (MACE)–free survival according to the presence or absence of lipid‐rich plaque (LRP) in patients with intact fibrous cap (IFC). Compared with patients with IFC–non‐LRP, patients with IFC‐LRP had the higher incidence of MACEs (A) and device‐oriented composite end point (DOCE; B). Compared with patients with IFC‐LRP, adjusted hazard ratio (HR) of those with IFC–non‐LRP was generated from multivariate Cox proportional hazards models, including hyperlipidemia and second‐generation drug‐eluting stents.

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  Figure 5. Incidence of major adverse cardiac events (MACEs) among 4 quadrants of maximum lipid arc, defined by optical coherence tomography (OCT) in patients with intact fibrous cap (IFC). Frequency of MACEs, according to each quadrant of maximum lipid arc defined by OCT in patients with IFC. When patients with IFC were divided into quadrants by maximum lipid arc defined by OCT, the frequency of MACEs was significantly higher in the larger maximum lipid arc.

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  Figure 6. Kaplan‐Meier curves showing major adverse cardiac event (MACE)–free survival classified by culprit plaque morphological characteristics by optical coherence tomography. Either 3‐group (A) or 4‐group (B) classifications of culprit plaque morphological characteristics can discriminate high‐risk patients for future MACEs after percutaneous coronary intervention. Compared with patients with plaque rupture, adjusted hazard ratio (HR) of those with intact fibrous cap (IFC)–non–lipid‐rich plaque (LRP) was generated from multivariate Cox proportional hazards model, including estimated glomerular filtration rate, prior myocardial infarction, second‐generation drug‐eluting stents, and American Heart Association/American College of Cardiology classification B2/C.