Objectives The aim of this study was to characterize the morphological features of plaque erosion and calcified nodule in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT). Background Plaque erosion and calcified nodule have not been systematically investigated in vivo. Methods A total of 126 patients with ACS who had undergone pre-intervention OCT imaging were included. The culprit lesions were classified as plaque rupture (PR), erosion (OCT-erosion), calcified nodule (OCT-CN), or with a new set of diagnostic criteria for OCT. Results The incidences of PR, OCT-erosion, and OCT-CN were 43.7%, 31.0%, and 7.9%, respectively. Patients with OCT-erosion were the youngest, compared with those with PR and OCT-CN (53.8 ± 13.1 years vs. 60.6 ± 11.5 years, 65.1 ± 5.0 years, p = 0.005). Compared with patients with PR, presentation with non-ST-segment elevation ACS was more common in patients with OCT-erosion (61.5% vs. 29.1%, p = 0.008) and OCT-CN (100% vs. 29.1%, p < 0.001). The OCT-erosion had a lower frequency of lipid plaque (43.6% vs. 100%, p < 0.001), thicker fibrous cap (169.3 ± 99.1 μm vs. 60.4 ± 16.6 μm, p < 0.001), and smaller lipid arc (202.8 ± 73.6 vs. 275.8 ± 60.4, p < 0.001) than PR. The diameter stenosis was least severe in OCT-erosion, followed by OCT-CN and PR (55.4 ± 14.7% vs. 66.1 ± 13.5% vs. 68.8 ± 12.9%, p < 0.001). Conclusions Optical coherence tomography is a promising modality for identifying OCT-erosion and OCT-CN in vivo. The OCT-erosion is a frequent finding in patients with ACS, especially in those with non-ST-segment elevation ACS and younger patients. The OCT-CN is the least common etiology for ACS and is more common in older patients. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
Bibliographical noteFunding Information:
This study was supported by research grants from St. Jude Medical, the Cardiology Division of Massachusetts General Hospital . Dr. Jia has received a grant from the National Natural Science Foundation of China (grant contract number: 81200076 ) and Open Foundation of Key Laboratory of Myocardial Ischemia (Harbin Medical University), Chinese Ministry of Education ( KF201205 ). Dr. Aguirre is funded by National Institute of Health T32HL094301 . Dr. Vergallo has received a grant from the Enrico ed Enrica Sovena Foundation , Italy. Dr. Dauerman has served as consultant to Medtronic and The Medicines Company; and has received research grants from Abbott Vascular and Medtronic . Dr. Zhang is an employee of St. Jude Medical. Dr. Yu has received a grant from the National Natural Science Foundation of China (grant contract number: 30871064/C140401 ). Dr. Virmani has received research support from Abbott Vascular, BioSensors International, Biotronik, Boston Scientific, Medtronic, MicroPort Medical, OrbusNeich Medical, SINO Medical Technology, and Terumo Corporation ; honoraria from Abbott Vascular, Boston Scientific, Terumo Corporation, and Lutonix; served as consultant to Abbott Vascular, 480 Biomedical, and WL Gore; and served on the speakers’ bureau for Merck. Dr. Jang has received research grants and consulting fees from LightLab Imaging/St. Jude Medical . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Stephen Nicholls, MBBS, PhD, served as Guest Editor for this article.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine