Culprit Plaque Morphology | Journal Scan

Study Questions:

What are the pathophysiological features and response to primary percutaneous coronary intervention (PCI) of nonruptured/eroded plaque versus ruptured plaque as a cause of ST-segment elevation myocardial infarction (STEMI)?

Methods:

The authors performed optical coherence tomography of the infarct-related artery (IRA) before PCI, after everolimus-eluting stent (EES) implantation and at 9-month follow-up in 140 patients with STEMI. Histopathology and immunohistochemistry of thrombus aspirates was also performed.

Results:

Culprit plaque morphology could be adjudicated in 97 patients. Of these, 32 plaques (33.0%) had an intact fibrous cap while the majority (n = 63, 64.9%) had a ruptured fibrous cap, and two had spontaneous dissections. Patients with an intact versus ruptured fibrous cap had similar clinical characteristics, serum inflammatory, and platelet biomarkers. An intact cap was more likely to present with a patent IRA (56% vs. 35%), and have fewer lipid areas (lipid-rich areas: 75.0% vs. 100.0%) and less residual thrombus before stenting. At the 9-month optical coherence tomography, intact and ruptured plaque had similar rates of stent strut coverage (92.5% vs. 91.2%) and similar percentage of volume obstruction (12.6% vs. 10.2%).

Conclusions:

An intact fibrous cap was observed in a third of patients with STEMI, but there was no difference in the vascular response to EES among patients with ruptured versus intact fibrous cap.

Perspective:

It has been previously speculated that the vascular healing in patients undergoing primary PCI might be different in patients with plaque rupture versus other mechanisms of plaque instability. This study suggests that the majority of patients with STEMI have plaque rupture as the inciting event and that the vascular healing does not appear to differ between those with an intact versus a ruptured fibrous cap.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Lipid Metabolism, Interventions and ACS, Interventions and Imaging

Keywords: Acute Coronary Syndrome, Biological Markers, Diagnostic Imaging, Drug-Eluting Stents, Immunohistochemistry, Lipids, Myocardial Infarction, Percutaneous Coronary Intervention, Sirolimus, Thrombosis, Tomography, Optical Coherence


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