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Relationship among clinical characteristics, morphological culprit plaque features, and long-term prognosis in patients with acute coronary syndrome

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Abstract

Culprit lesions of acute coronary syndrome (ACS) could be classified as plaque rupture (PR), erosion, or calcified nodule (CN). We aimed to determine the relationship among clinical characteristics, morphological plaque features, and long-term prognosis in ACS. Patients with ACS, who underwent pre-intervention optical coherence tomography between April 2013 and July 2018 were retrospectively enrolled, and classified into the three groups based on the culprit lesion morphology. In the 436 patients enrolled, incidences of PR, erosion, and CN in ACS culprit lesions were 46.1, 39.9, and 14.0%, respectively. Plaque erosion was more frequent in men aged < 60 years and CN was more frequent in older adults in both sexes (≥ 80 years) (P < 0.001). Patients with CN had a higher incidence of hemodialysis treatment (P < 0.001) and diabetes (P = 0.003). Multivariate analysis revealed that ST elevation myocardial infarction (STEMI) (P = 0.049) and presence of thin-cap fibroatheroma (TCFA) at the culprit lesion were independently associated with PR; in younger patients (< 60 year), preserved left ventricular ejection fraction and lower incidence of TCFA were correlated with plaque erosion; and older age, non-STEMI, or unstable angina pectoris, higher serum brain natriuretic peptide levels, and lower incidence of TCFA were independently associated with CN. Multivariable analysis revealed that CN (odds ratio [OR] 1.990, P = 0.005), male sex (OR 2.012, P = 0.004), and older age (OR 1.036, P < 0.001) were independently associated with future adverse events during a median follow-up of 757 days. Different patient characteristics and morphological features were associated with the type of culprit lesion in patients with ACS.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275. https://doi.org/10.1161/01.atv.20.5.1262

    Article  CAS  PubMed  Google Scholar 

  2. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, Badimon JJ, Stefanadis C, Moreno P, Pasterkamp G, Fayad Z, Stone PH, Waxman S, Raggi P, Madjid M, Zarrabi A, Burke A, Yuan C, Fitzgerald PJ, Siscovick DS, de Korte CL, Aikawa M, Airaksinen KEJ, Assmann G, Becker CR, Chesebro JH, Farb A, Galis ZS, Jackson C, Jang IK, Koenig W, Lodder RA, March K, Demirovic J, Navab M, Priori SG, Rekhter MD, Bahr R, Grundy SM, Mehran R, Colombo A, Boerwinkle E, Ballantyne C, Insull W Jr, Schwartz RS, Vogel R, Serruys PW, Hansson GK, Faxon DP, Kaul S, Drexler H, Greenland P, Muller JE, Virmani R, Ridker PM, Zipes DP, Shah PK, Willerson JT (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108:1664–1672. https://doi.org/10.1161/01.CIR.0000087480.94275.97

    Article  PubMed  Google Scholar 

  3. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, ESC Scientific Document Group (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40:237–269. https://doi.org/10.1093/eurheartj/ehy462

    Article  Google Scholar 

  4. Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50:933–939. https://doi.org/10.1016/j.jacc.2007.04.082

    Article  PubMed  Google Scholar 

  5. Kazuo K (2018) JCS 2018 Guideline on diagnosis and treatment of acute coronary syndrome. https://www.j-circ.or.jp/old/guideline/pdf/JCS2018_kimura.pdf. Accessed 12 Apr 2021

  6. Kataiwa H, Tanaka A, Kitabata H, Imanishi T, Akasaka T (2008) Safety and usefulness of non-occlusion image acquisition technique for optical coherence tomography. Circ J 72:1536–1537. https://doi.org/10.1253/circj.cj-08-0406

    Article  PubMed  Google Scholar 

  7. Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK (2013) In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol 62:1748–1758. https://doi.org/10.1016/j.jacc.2013.05.071

    Article  PubMed  Google Scholar 

  8. Lee T, Mintz GS, Matsumura M, Zhang W, Cao Y, Usui E, Kanaji Y, Murai T, Yonetsu T, Kakuta T, Maehara A (2017) Prevalence, predictors, and clinical presentation of a calcified nodule as assessed by optical coherence tomography. JACC Cardiovasc Imaging 10:883–891. https://doi.org/10.1016/j.jcmg.2017.05.013

    Article  PubMed  Google Scholar 

  9. Yonetsu T, Lee T, Murai T, Suzuki M, Matsumura A, Hashimoto Y, Kakuta T (2016) Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography. Int J Cardiol 203:766–774. https://doi.org/10.1016/j.ijcard.2015.11.030

    Article  PubMed  Google Scholar 

  10. Kini AS, Vengrenyuk Y, Yoshimura T, Matsumura M, Pena J, Baber U, Moreno P, Mehran R, Maehara A, Sharma S, Narula J (2017) Fibrous cap thickness by optical coherence tomography in vivo. J Am Coll Cardiol 69:644–657. https://doi.org/10.1016/j.jacc.2016.10.028

    Article  PubMed  Google Scholar 

  11. Kang SJ, Mintz GS, Akasaka T, Park DW, Lee JY, Kim WJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ (2011) Optical coherence tomographic analysis of in-stent neoatherosclerosis after drug-eluting stent implantation. Circulation 123:2954–2963. https://doi.org/10.1161/CIRCULATIONAHA.110.988436

    Article  CAS  PubMed  Google Scholar 

  12. Takano M, Yamamoto M, Inami S, Murakami D, Ohba T, Seino Y, Mizuno K (2009) Appearance of lipid-laden intima and neovascularization after implantation of bare-metal stents: extended late-phase observation by intracoronary optical coherence tomography. J Am Coll Cardiol 55:26–32. https://doi.org/10.1016/j.jacc.2009.08.032

    Article  PubMed  Google Scholar 

  13. Nagano Y, Otake H, Toba T, Kuroda K, Shinkura Y, Tahara N, Tsukiyama Y, Yanaka K, Yamamoto H, Nagasawa A, Onishi H, Sugizaki Y, Takeshige R, Harada A, Murakami K, Kiriyama M, Oshita T, Irino Y, Kawamori H, Ishida T, Toh R, Shinke T, Hirata KI (2019) Impaired cholesterol-uptake capacity of HDL might promote target-lesion revascularization by inducing neoatherosclerosis after stent implantation. J Am Heart Assoc 8:e011975. https://doi.org/10.1161/JAHA.119.011975

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sato Y, Hatakeyama K, Yamashita A, Marutsuka K, Sumiyoshi A, Ysada A (2005) Proportion of fibrin and platelets differs in thrombi on ruptured and eroded coronary atherosclerotic plaques in humans. Heart 91:526–530. https://doi.org/10.1136/hrt.2004.034058

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Falk E (2006) Pathogenesis of atherosclerosis. J Am Coll Cardiol 47:C7–C12. https://doi.org/10.1016/j.jacc.2005.09.068

    Article  CAS  PubMed  Google Scholar 

  16. Tanimoto T, Imanishi T, Tanaka A, Yamano T, Kitabata H, Takarada S, Kubo T, Nakamura N, Hirata K, Mizukoshi M, Akasaka T (2009) Various types of plaque disruption in culprit coronary artery visualized by optical coherence tomography in a patient with unstable angina. Circ J 73:187–189. https://doi.org/10.1253/circj.cj-07-0715

    Article  PubMed  Google Scholar 

  17. Burke AP, Farb A, Malcom GT, Liang Y, Smialek J, Virmani R (1998) Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation 97:2110–2116. https://doi.org/10.1161/01.cir.97.21.2110

    Article  CAS  PubMed  Google Scholar 

  18. Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J, Virmani R (1996) Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation 93:1354–1363. https://doi.org/10.1161/01.cir.93.7.1354

    Article  CAS  PubMed  Google Scholar 

  19. Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fracassi F, Sugiyama T, Lee H, Crea F, Kimura T, Fujimoto JG, Fuster V, Jang IK (2019) Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes. J Am Heart Assoc 8:e012322. https://doi.org/10.1161/JAHA.119.012322

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hassani SE, Mintz GS, Fong HS, Kim SW, Xue Z, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R, Weissman NJ (2006) Negative remodeling and calcified plaque in octogenarians with acute myocardial infarction: an intravascular ultrasound analysis. J Am Coll Cardiol 50:2413–2419. https://doi.org/10.1016/j.jacc.2005.11.091

    Article  Google Scholar 

  21. Lee SY, Mintz GS, Kim SK, Hong YJ, Kim SW, Okabe T, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R, Weissman NJ (2009) Attenuated plaque detected by intravascular ultrasound clinical, angiographic, and morphologic features and post-percutaneous coronary intervention complications in patients with acute coronary syndromes. JACC Cardiovasc Interv 2:65–72. https://doi.org/10.1016/j.jcin.2008.08.022

    Article  PubMed  Google Scholar 

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Acknowledgement

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Akira Nagasawa, Hiromasa Otake, Hiroyuki Kawamori, Takayoshi Toba, Yoichiro Sugizaki, Ryo Takeshige, Shinsuke Nakano, Kosuke Tanimura, Yu Takahashi, Yusuke Fukuyama & Ken-ichi Hirata

  2. Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan

    Amane Kozuki & Junya Shite

  3. Division of Cardiovascular Medicine, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan

    Masamichi Iwasaki & Koji Kuroda

  4. Division of Cardiovascular Medicine, Hyogo Prefectural Himeji Cardiovascular Center, Himeji, Japan

    Tomofumi Takaya

Authors
  1. Akira Nagasawa
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  2. Hiromasa Otake
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  3. Hiroyuki Kawamori
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  4. Takayoshi Toba
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  14. Koji Kuroda
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  15. Tomofumi Takaya
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  16. Ken-ichi Hirata
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Akira Nagasawa and Hiromasa Otake. The first draft of the manuscript was written by Akira Nagasawa and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiromasa Otake.

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Conflict of interest

H.O., J.S., A.K., and T.T. received lecture fee from Abbott Vascular. K.H. received grant support from Abbott Vascular. Other authors have no financial conflict of interest to disclose concerning the study.

Ethics approval

The study protocol complied with the Declaration of Helsinki and was approved by the ethical committee of each institution.

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The requirement for written informed consent was waived because this study used only retrospective data.

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Nagasawa, A., Otake, H., Kawamori, H. et al. Relationship among clinical characteristics, morphological culprit plaque features, and long-term prognosis in patients with acute coronary syndrome. Int J Cardiovasc Imaging 37, 2827–2837 (2021). https://doi.org/10.1007/s10554-021-02252-w

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  • DOI: https://doi.org/10.1007/s10554-021-02252-w

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