In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients With Acute Coronary Syndrome by Intravascular Optical Coherence Tomography
Key result
OCT identifies plaque rupture as the primary ACS culprit, occurring in ~44% of cases.
- n=126
Why the study?
Plaque erosion and calcified nodule have not been systematically investigated in vivo in patients with acute coronary syndrome using optical coherence tomography.
What are the in vivo morphological features and incidences of plaque erosion and calcified nodule in patients with acute coronary syndrome assessed by OCT?
Comparison
Plaque rupture vs OCT-erosion vs OCT-calcified nodule
Design
Observational study using OCT imaging
Authors
Discussion
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Implication
In vivo OCT imaging demonstrates that plaque erosion is a frequent etiology of ACS (31.0%), particularly in younger patients and those presenting with NSTE-ACS, and exhibits distinct morphological features compared to plaque rupture.
Key Points
- To characterize the in vivo morphological features and clinical presentations of plaque erosion and calcified nodules in patients presenting with acute coronary syndrome using optical coherence tomography.
- Evaluated 126 patients with acute coronary syndrome who underwent pre-intervention intravascular optical coherence tomography (OCT) imaging.
- Classified culprit lesions into plaque rupture, OCT-erosion, calcified nodule (OCT-CN), or other etiologies using established diagnostic criteria.
- Plaque rupture occurred in 43.7% of patients, OCT-erosion in 31.0%, and OCT-CN in 7.9%, with erosion presenting in significantly younger patients than rupture or nodules (53.8±13.1 vs. 60.6±11.5 and 65.1±5.0 years; p=0.005).
- Non-ST-segment elevation presentation was more common in OCT-erosion (61.5% vs. 29.1%, p=0.008) and OCT-CN (100% vs. 29.1%, p<0.001) than in plaque rupture.
- OCT-erosion lesions had less lipid plaque (43.6% vs. 100%, p<0.001), thicker fibrous caps (169.3±99.1 μm vs. 60.4±16.6 μm, p<0.001), and less diameter stenosis (55.4±14.7% vs. 68.8±12.9%, p<0.001) than plaque rupture.
Study Design
Type
Observational (n=126)
Structured PICO
What are the in vivo morphological features and incidences of plaque erosion and calcified nodule in patients with acute coronary syndrome assessed by OCT?
P
Population
126 patients with acute coronary syndrome who underwent pre-intervention optical coherence tomography imaging.
E
Exposure
Intravascular Optical Coherence Tomography (OCT) imaging
O
Outcome
Incidence and morphological features of culprit lesions (plaque rupture, plaque erosion, calcified nodule)surrogate
In vivo OCT imaging demonstrates that plaque erosion is a frequent etiology of ACS (31.0%), particularly in younger patients and those presenting with NSTE-ACS, and exhibits distinct morphological features compared to plaque rupture.
Cite This Study
Jia et al. (2013) conducted an observational in Acute coronary syndrome (ACS) (n=126). Plaque erosion (OCT-erosion) vs. Plaque rupture (PR) was evaluated on Incidence of culprit lesion morphologies (plaque rupture, OCT-erosion, and calcified nodule). In patients with ACS, OCT identified plaque rupture in 43.7%, plaque erosion in 31.0%, and calcified nodule in 7.9%, with erosion being more common in younger patients and NSTE-ACS.