Key result
In STEMI patients with plaque erosion, culprit lesions with microchannels had a higher incidence of lipid plaque (59.5% vs. 45.3%, P=0.012) and macrophage accumulation (72.4% vs. 45.7%, P<0.001).
Why the study?
Knowledge regarding microchannels and culprit lesion vulnerability in patients with OCT-defined plaque erosion was limited.
Are microchannels associated with more vulnerable plaque features and severe luminal stenosis in STEMI patients with plaque erosion?
Observational (n=348)
No
Are microchannels associated with more vulnerable plaque features and severe luminal stenosis in STEMI patients with plaque erosion?
Absolute Event Rate: 59.5% vs 45.3%
p-value: p=0.012
In STEMI patients with plaque erosion, the presence of microchannels on OCT is associated with more severe luminal stenosis and vulnerable plaque features.
Microchannels on OCT may flag higher-risk erosion lesions in STEMI; leaves open whether they guide therapy or predict events.
Objective: Microchannels are associated with the progression of atherosclerotic vulnerable plaques. However, in patients with culprit optical coherence tomography (OCT)-defined plaque erosion, the knowledge of microchannels and culprit lesion vulnerability is limited. The aim of this study was to investigate culprit lesion characteristics in patients with ST-segment elevated myocardial infarction (STEMI) caused by plaque erosion with and without microchannels using OCT. Methods: In all, 348 STEMI patients with plaque erosion who underwent OCT of the culprit lesion at the 2 nd Affiliated Hospital of Harbin Medical University (Harbin, China) from August 2014 to December 2017 were included and divided into the microchannel group ( n = 116, 33.3%) and no-microchannel group ( n = 232, 66.7%). The clinical characteristics and OCT-derived plaque features were compared between both groups. Results: Among the 348 STEMI patients with plaque erosion, culprit lesions with microchannels had higher incidence of lipid plaque (59.5% vs. 45.3%, P = 0.012); calcification (41.4% vs. 24.6%, P = 0.002); spotty calcification (30.2% vs. 18.1%, P = 0.014); macrophages accumulation (72.4% vs. 45.7%, P < 0.001); and cholesterol crystals (32.8% vs. 14.2%, P < 0.001) than those without microchannels. In addition, minimal lumen area was smaller ((1.9 ± 0.9) mm 2 vs. (2.8 ± 2.3) mm 2 , P < 0.001) and lumen area stenosis was greater ((71.3% ± 13.4%) vs. (65.3% ± 19.3%), P = 0.001) in the microchannel group than in the no-microchannel group. Conclusion: In patients with STEMI caused by plaque erosion, one-third manifested typical microchannel characteristics, and those with microchannels were associated with more severe luminal stenosis and more vulnerable plaque features than those without microchannels.
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Jiang et al. (2022) conducted an observational in ST-segment elevation myocardial infarction with plaque erosion (n=348). Microchannels vs. No microchannels was evaluated on Incidence of lipid plaque (p=0.012). In STEMI patients with plaque erosion, culprit lesions with microchannels had a higher incidence of lipid plaque (59.5% vs. 45.3%, P=0.012) and macrophage accumulation (72.4% vs. 45.7%, P<0.001).
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