Author + information
- Kirstine Hansen1,
- Lisbeth Antonsen2,
- Akiko Maehara3,
- Michael Maeng4,
- Julia Ellert5,
- lars jakobsen4,
- Niels Holm6,
- Ole Ahlehoff1,
- Troels Thim4,
- Karsten Veien7,
- Christian Oliver Fallesen8,
- Evald Christiansen4 and
- Lisette Okkels Jensen7
- 1Odense Universitets Hospital, Odense, Denmark
- 2Odense Universitetshospital, Odense, Denmark
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4Aarhus University Hospital, Aarhus, Denmark
- 5OUH, Esbjerg, Denmark
- 6Aarhus University Hospital, Aarhus N, Denmark
- 7Department of Cardiology, Odense University Hospital, Odense, Denmark
- 8Odense University Hospital, middelfart, Denmark
In patients with ST-segment elevation myocardial infarction (STEMI), plaque rupture (PR) and non-ruptured plaque (NRP) with intact fibrous cap are the most common underlying mechanism. The culprit lesion and the underlying plaque morphology can be assessed with optical coherence tomography (OCT). This study sought to evaluate the incidence of PR and NRP in STEMI patients using OCT to compare detailed plaque morphology in the culprit lesion.
OCT was performed prior to stent implantation in STEMI-patients. Plaque morphology was analyzed using off-line semi-automatic analysis software, and the culprit lesions were categorized as either PR or NRP. The percentage of each plaque component was summed over the total length of the lesion, and calculated as the total degree of plaque component/total degrees analyzed in the lesion×100.
In 50 STEMI-patients, pre-stent OCT images were analyzable. Of these, 36 patients (72.0 %) presented with PR and 14 patients (28.0 %) with NRP. Patients with PR and NRP had similar clinical characteristics, except, that patients with PR were older than patients with NRP (64.4±10.5 vs. 55.4±11.1, p=0.010). Compared to NRPs, PRs contained significantly more lipid plaque (58.0%±15.0 vs. 45.7%±11.8, p=0.008), more superficial (7.8%±4.1 vs. 5.1%±3.5, p=0,034) and profound bright spots (2.9%±2.7 vs. 0.7%±0.9, p=0.004) indicating macrophage infiltration, more thin-cap fibroatheromas (TCFA) (1.7±1.1 vs. 0.8±0.8, p= 0.004), and the TCFA lengths were significantly longer (5.1 mm ± 3.6 vs. 1.8 mm ± 2.4, p=0.003). PR had less fibrotic plaque (13.0%±7.0 vs. 20.5%±12.9, p=0.011) and white thrombus (2.5%±2.2 vs. 6.0%±4.1, p<0.001) compared to NRPs.
One-third of STEMI patients had culprit lesions without OCT-detectable ruptured plaque. Culprit lesions with NRP contained less vulnerable plaque components, such as lipid pools, TCFAs and macrophages compared to PRs lesions.
IMAGING: Vulnerable Plaque