Korean Circ J.  2016 Jul;46(4):499-506. 10.4070/kcj.2016.46.4.499.

Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

• Kwon JE
• Lee WS
• Mintz GS
• Hong YJ
• Lee SY
• Kim KS
• Hahn JY
• Sharath Kumar KS
• Won H
• Hyeon SH
• Shin SY
• Lee KJ
• Kim TH
• Kim CJ
• Kim SW

• KMID: 2344424
• DOI: http://doi.org/10.4070/kcj.2016.46.4.499

Abstract

BACKGROUND AND OBJECTIVES
We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice.
SUBJECTS AND METHODS
Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05.
RESULTS
A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29).
CONCLUSION
Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.

Keyword

Optical coherence tomography; Atherosclerotic plaque; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome*
Humans
Membranes
Myocardial Infarction
Plaque, Atherosclerotic
Rupture*
Thrombosis
Tomography, Optical Coherence
Ultrasonography

Figure

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  Fig. 1 Optical coherence tomography finding of plaque erosion. (A-C) Definite plaque erosion, intracoronary thrombi (arrow) attaching to the luminal surface were noted without detectable signs of fibrous cap rupture. (D) Probable plaque erosion, coronary luminal surface irregularity (arrow) with the absence of thrombus was noted at the culprit lesion.

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  Fig. 2 Frequency distribution of plaque rupture/erosion at culprit according to distance from each coronary ostium of the LAD, the LCX, and the RCA. Plaque rupture and plaque erosions are shown separately. The distribution pattern of plaque rupture was similar (p=0.29) to that of plaque erosions. LAD: left anterior descending coronary artery, LCX: left circumflex coronary artery, RCA: right coronary artery.

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