Plaque Rupture and Acute Coronary Syndrome | Journal Scan

Study Questions:

What is the prognostic value of plaque rupture (PR), compared with intact fibrous cap (IFC), in patients with acute coronary syndrome (ACS)?

Methods:

The investigators enrolled consecutive patients admitted to their coronary care unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis was assessed according to such culprit lesion classification. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, nonfatal myocardial infarction, unstable angina, and target lesion revascularization (follow-up mean time 31.58 ± 4.69 months). The researchers performed a simple Cox regression analysis using all variables on their original continuous scale to estimate the unadjusted hazard ratios of all variables.

Results:

The study enrolled 139 consecutive ACS patients (mean age 64.3 ± 12.0 years, male 73.4%, 92 patients with non-ST elevation ACS and 47 with ST-elevation ACS). Plaque rupture was detected in 82/139 (59%) patients. There were no differences in clinical, angiographic, or procedural data between patients with PR when compared with those having IFC. MACE occurred more frequently in patients with PR when compared with those having IFC (39.0 vs. 14.0%, p = 0.001). Plaque rupture was an independent predictor of outcome with multivariable analysis (odds ratio, 3.735; confidence interval, 1.358–9.735).

Conclusions:

The authors concluded that patients with ACS presenting with PR as the culprit lesion by OCT have a worse prognosis compared with that of patients with IFC.

Perspective:

This study reports that patients with an ACS having PR assessed by OCT as a mechanism of coronary instability have a worse prognosis after medium-term follow-up when compared with those having an IFC by OCT. Worse outcomes are mainly driven by a higher risk of unstable angina and of target vessel revascularization at follow-up. If confirmed in larger trials, tailored or individualized therapies should be investigated in the patient subset with PR to help improve outcomes.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Tomography, Optical Coherence, Coronary Angiography, Angiography, Angina, Unstable, Myocardial Infarction, Coronary Care Units, Prognosis, Regression Analysis


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