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New insights into spotty calcification and plaque rupture in acute coronary syndrome: an optical coherence tomography study

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Abstract

Although recent optical coherence tomography (OCT) studies have focused on spotty calcification, whether there were any characteristics in the concomitant existence of calcification and plaque rupture remains unknown. The aim of the present study was to investigate the characteristics of spotty calcification in acute coronary syndrome (ACS) patients with or without plaque rupture, using OCT. This study enrolled 98 consecutive patients with ACS. OCT image acquisitions were performed in the culprit lesions, and patients were divided into the plaque rupture group (n = 38) and the non-rupture group (n = 60). The frequency of spotty calcification (p = 0.006), thin-capped fibroatheroma (p = 0.012), macrophage infiltration (p = 0.022), and the number of spotty calcification per patient (p < 0.001) were significantly higher and the largest arc and the minimum depth of spotty calcification from the luminal surface were significantly smaller in the rupture group. Moreover, in the rupture group, most of the spotty calcifications in the site nearest to the minimum lumen area were observed in the proximal portion of that site, and tended to be located near the plaque rupture. Multivariate analysis revealed that the presence of spotty calcification (OR 3.19, 95 % CI 1.12–9.76, p = 0.030) and age (OR 1.08, 95 % CI 1.02–1.14, p = 0.008) were independent predictive factors for plaque rupture. This study demonstrates the characteristics of spotty calcification in ACS patients with plaque rupture and the positional relationship between spotty calcification and plaque rupture. These detailed observations could impact on treatment strategies for the prevention of ACS.

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References

  1. Frink RJ, Achor RW, Brown AL Jr, Kincaid OW, Brandenburg RO (1970) Significance of calcification of the coronary arteries. Am J Cardiol 26:241–247

    Article  CAS  PubMed  Google Scholar 

  2. Beckman JA, Ganz J, Creager MA, Ganz P, Kinlay S (2001) Relationship of clinical presentation and calcification of culprit coronary artery stenoses. Arterioscler Thromb Vasc Biol 21:1618–1622

    Article  CAS  PubMed  Google Scholar 

  3. Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D, Nakamura Y, Yamashita H, Yamagishi H, Takeuchi K, Naruko T, Haze K, Becker AE, Yoshikawa J, Ueda M (2004) Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation 110:3424–3429

    Article  PubMed  Google Scholar 

  4. Fujii K, Carlier SG, Mintz GS, Takebayashi H, Yasuda T, Costa RA, Moussa I, Dangas G, Meran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB (2005) Intravascular ultrasound study of patterns of calcium in ruptured coronary plaques. Am J Cardiol 96:352–357

    Article  CAS  PubMed  Google Scholar 

  5. Ehara S, Kobayashi Y, Kataoka T, Yoshiyama M, Ueda M, Yoshikawa J (2007) Quantification of coronary calcification by intravascular ultrasound. Circ J 71:530–535

    Article  PubMed  Google Scholar 

  6. Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, Naruse H, Ishii J, Hishida H, Wong ND, Virmani R, Kondo T, Ozaki Y, Narula J (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57

    Article  PubMed  Google Scholar 

  7. Burke AP, Weber DK, Kolodgie FD, Farb A, Taylor AJ, Virmani R (2001) Pathophysiology of calcium deposition in coronary arteries. Herz 26:239–244

    Article  CAS  PubMed  Google Scholar 

  8. Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial plaque by optical coherence tomography. Am J Cardiol 97:1172–1175

    Article  PubMed  Google Scholar 

  9. Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106:1640–1645

    Article  PubMed  Google Scholar 

  10. Ikuta S, Kobuke K, Iwanaga Y, Nakauchi Y, Yamaji K, Miyazaki S (2014) Difference in neointimal coverage at chronic stage between bare metal stent and sirolimus-eluting stent evaluated at stent-strut level by optical coherence tomography. Heart Vessels 29:320–327

    Article  PubMed  Google Scholar 

  11. Ueda T, Uemura S, Watanabe M, Sugawara Y, Soeda T, Okayama S, Takeda Y, Kawata H, Kawakami R, Saito Y (2014) Colocalization of thin-cap fibroatheroma and spotty calcification is a powerful predictor of procedure-related myocardial injury after elective coronary stent implantation. Coron Artery Dis 25:384–391

    Article  PubMed  Google Scholar 

  12. Kataoka Y, Puri R, Hammadah M, Duggal B, Uno K, Kapadia SR, Tuzcu EM, Nissen SE, Nicholls SJ (2014) Spotty calcification and plaque vulnerability in vivo: frequency-domain optical coherence tomography analysis. Cardiovasc Diagn Ther 4:460–469

    PubMed  PubMed Central  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. Takarada S, Imanishi T, Liu Y, Ikejima H, Tsujioka H, Kuroi A, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Kitabata H, Kubo T, Nakamura N, Hirata K, Tanaka A, Mizukoshi M, Akasaka T (2010) Advantage of next-generation frequency-domain optical coherence tomography compared with conventional time-domain system in the assessment of coronary lesion. Catheter Cardiovasc Interv 75:202–206

    Article  PubMed  Google Scholar 

  15. Okamura T, Onuma Y, Garcia-Garcia HM, van Geuns RJ, Wykrzykowska JJ, Schultz C, van der Giessen WJ, Ligthart J, Regar E, Serruys PW (2011) First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: a comparison with intravascular ultrasound and quantitative coronary angiography. EuroIntervention 6:1037–1045

    Article  PubMed  Google Scholar 

  16. Hasegawa T, Otsuka K, Iguchi T, Matsumoto K, Ehara S, Nakata S, Nishimura S, Kataoka T, Shimada K, Yoshiyama M (2014) Serum n-3 to n-6 polyunsaturated fatty acids ratio correlates coronary plaque vulnerability: an optical coherence tomography study. Heart Vessels 29:596–602

    Article  PubMed  Google Scholar 

  17. Ehara S, Hasegawa T, Nakata S, Matsumoto K, Nishimura S, Iguchi T, Kataoka T, Yoshikawa J, Yoshiyama M (2012) Hyperintense plaque identified by magnetic resonance imaging relates to intracoronary thrombus as detected by optical coherence tomography in patients with angina pectoris. Eur Heart J Cardiovasc Imaging 13:394–399

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yang X, Gai L, Dong W, Liu H, Sun Z, Tian F, Chen Y (2013) Characterization of culprit lesions in acute coronary syndromes compared with stable angina pectoris by dual-source computed tomography. Int J Cardiovasc Imaging 29:945–953

    Article  PubMed  Google Scholar 

  19. Mizukoshi M, Kubo T, Takarada S, Kitabata H, Ino Y, Tanimoto T, Komukai K, Tanaka A, Imanishi T, Akasaka T (2013) Coronary superficial and spotty calcium deposits in culprit coronary lesions of acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol 112:34–40

    Article  CAS  PubMed  Google Scholar 

  20. Wada S, Mitsui N, Mukai S, Sueda T, Matsuura Y, Roques XF, Laborde MN, Yssartier F, Baudet EM (1994) Rupture of donor ascending aorta following heart transplantation. Hiroshima J Med Sci 43:73–76

    CAS  PubMed  Google Scholar 

  21. Hoshino T, Chow LA, Hsu JJ, Perlowski AA, Abedin M, Tobis J, Tintut Y, Mal AK, Klug WS, Demer LL (2009) Mechanical stress analysis of a rigid inclusion in distensible material: a model of atherosclerotic calcification and plaque vulnerability. Am J Physiol Heart Circ Physiol 297:H802–H810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Samady H, Eshtehardi P, McDaniel MC, Suo J, Dhawan SS, Maynard C, Timmins LH, Quyyumi AA, Giddens DP (2011) Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease. Circulation 124:779–788

    Article  CAS  PubMed  Google Scholar 

  23. Teng Z, Brown AJ, Calvert PA, Parker RA, Obaid DR, Huang Y, Hoole SP, West NE, Gillard JH, Bennett MR (2014) Coronary plaque structural stress is associated with plaque composition and subtype and higher in acute coronary syndrome: the BEACON I (biomechanical evaluation of atheromatous coronary arteries) study. Circ Cardiovasc Imaging 7:461–470

    Article  PubMed  Google Scholar 

  24. de Graaf MA, van Velzen JE, de Graaf FR, Schuijf JD, Dijkstra J, Bax JJ, Reiber JH, Schalij MJ, van der Wall EE, Jukema JW (2013) The maximum necrotic core area is most often located proximally to the site of most severe narrowing: a virtual histology intravascular ultrasound study. Heart Vessels 28:166–172

    Article  PubMed  Google Scholar 

  25. 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

    Article  CAS  PubMed  Google Scholar 

  26. 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 47:2413–2419

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka, 545-8586, Japan

    Mikumo Sakaguchi, Takao Hasegawa, Shoichi Ehara, Kenji Matsumoto, Kazuki Mizutani, Hideshi Ishii, Masashi Nakagawa, Kenei Shimada & Minoru Yoshiyama

  2. Department of Medicine, Bell-land General Hospital, Osaka, Japan

    Tomokazu Iguchi

Authors
  1. Mikumo Sakaguchi
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  2. Takao Hasegawa
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  3. Shoichi Ehara
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  4. Kenji Matsumoto
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  5. Kazuki Mizutani
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  10. Minoru Yoshiyama
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Correspondence to Takao Hasegawa.

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Sakaguchi, M., Hasegawa, T., Ehara, S. et al. New insights into spotty calcification and plaque rupture in acute coronary syndrome: an optical coherence tomography study. Heart Vessels 31, 1915–1922 (2016). https://doi.org/10.1007/s00380-016-0820-3

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  • DOI: https://doi.org/10.1007/s00380-016-0820-3

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