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Morphological characteristics of optical coherence tomography defined plaque fissure in patients with acute coronary syndrome

  • Mayank Goyal
  • Sang Wook Kim
  • Sundeep Mishra
  • Saima Sharmin
  • Hoyoun Won
  • Iksung Cho
  • Moon Ki Jung
  • Seung Yong Shin
  • Kwang Je Lee
  • Tae Ho Kim
  • Chee Jeong Kim
  • Wang Soo Lee
Original Article

Abstract

We assessed the plaque disruption in 245 consecutive patients with acute coronary syndrome undergoing percutaneous coronary intervention. The plaque fissure was diagnosed with optical coherence tomography, and intravascular ultrasound was used to determine arterial remodeling. Of them, 26 fissures were found in this study. The definite fissure was seen in 17 (65.4%) and probable fissure was seen in 9 (34.6%) patients. In 18 (69.2%), plaque fissure component was lipidic or thin-capped fibroatheroma. Eighteen (69.2%) of fissured plaque were seen within 30 mm of coronary ostium. Combined plaque fissure with plaque rupture/erosion was seen in 21 (80.8%) cases. The isolated fissure was seen in 5 (19.2%). Compared to the maximal necrotic core site of the ruptured plaque, the fissure site showed a smaller %necrotic core (p = 0.012), however, greater in fissure site than minimal lumen area site (24.93 ± 11.50% vs 15.34 ± 10.40%, p < 0.0001). The remodeling index was higher at fissure site as compared to minimal lumen area site (1.02 ± 0.22 vs 0.94 ± 0.27; p = 0.047), but similar to the rupture plaque (p = 0.31). The frequency of positive remodeling was 34.6% (9/26) at the plaque fissure. Although the plaque fissure can be interchangeable with the rupture in acute coronary syndrome, the limited extension to the small lipid core might and less positive remodeling provoke a fissuring of the plaque. Further study is necessary to assess the plaque fissure.

Keywords

Plaque fissure Optical coherence tomography Acute coronary syndrome 

Abbreviations

ACS

Acute coronary syndrome

EEM

External elastic membrane

ECG

Electrocardiogram

IVUS

Intravascular ultrasound

MLA

Minimal lumen area

NSTEMI

Non-ST elevation myocardial infarction

OCT

Optical coherent tomography

PCI

Percutaneous coronary intervention

P&M

Plaque and media

QCA

Quantitative coronary angiography

TIMI

Thrombolysis in Myocardial Infarction

STEMI

ST elevation myocardial infarction

PR

Plaque rupture

PE

Plaque erosion

TCFA

Thin-capped fibroatheroma

VH-IVUS

Virtual-Histology Intravascular Ultrasound

Notes

Acknowledgements

The author thanks to YM Jo and DW Kang, researchers of Heart Research Institute, for their efforts to collect and review the cases, and KS Park, MPH, for her statistical assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Mayank Goyal
    • 1
  • Sang Wook Kim
    • 1
  • Sundeep Mishra
    • 2
  • Saima Sharmin
    • 1
  • Hoyoun Won
    • 1
  • Iksung Cho
    • 1
  • Moon Ki Jung
    • 1
  • Seung Yong Shin
    • 1
  • Kwang Je Lee
    • 1
  • Tae Ho Kim
    • 1
  • Chee Jeong Kim
    • 1
  • Wang Soo Lee
    • 1
  1. 1.Heart Research Institute, Cardiovascular-Arrhythmia Center, College of MedicineChung-Ang University HospitalSeoulKorea
  2. 2.All India Institute of Medical ScienceNew DelhiIndia

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