In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients With Acute Coronary Syndrome by Intravascular Optical Coherence Tomography

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Article

Jia, Haibo^1,2  Abtahian, Farhad²  Aguirre, Aaron D.^3,9  Lee, Stephen⁴  Chia, Stanley⁵  Lowe, Harry⁶  Kato, Koji²  Yonetsu, Taishi²  Vergallo, Rocco²  Hu, Sining^1,2  Tian, Jinwei^1,2  Lee, Hang⁷  Park, Seung-Jung⁸  Jang, Yang-Soo^3,9  Raffel, Owen C.¹⁰  Mizuno, Kyoichi¹¹  Uemura, Shiro¹²  Itoh, Tomonori¹³  Kakuta, Tsunekazu¹⁴  Choi, So-Yeon¹⁵  Dauerman, Harold L.¹⁶  Prasad, Abhiram¹⁷  Toma, Catalin¹⁸  McNulty, Iris²  Zhang, Shaosong¹⁹  Yu, Bo¹  Fuster, Valentine²⁰  Narula, Jagat²⁰  Virmani, Renu²¹  Jang, Ik-Kyung² 

[1] Harbin Med Univ, Affiliated Hosp 2, Dept Cardiol, Key Lab Myocardial Ischemia,Chinese Minist Educ, Harbin 150086, Peoples R China

[2] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Div Cardiol, Boston, MA 02115 USA

[3] Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA

[4] Univ Hong Kong, Queen Mary Hosp, Dept Med, Hong Kong, Hong Kong, Peoples R China

[5] Natl Heart Ctr Singapore, Singapore, Singapore

[6] Concord Repatriat Gen Hosp, Sydney, NSW, Australia

[7] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Boston, MA 02115 USA

[8] Asan Med Ctr, Seoul, South Korea

[9] Yonsei Univ, Severance Cardiovasc Hosp, Seoul 120749, South Korea

[10] Prince Charles Hosp, Brisbane, Qld 4032, Australia

[11] Nippon Med Sch, Dept Cardiovasc Med, Tokyo 113, Japan

[12] Nara Med Univ, Nara, Japan

[13] Iwate Med Sch, Mem Heart Ctr, Div Cardiol, Morioka, Iwate, Japan

[14] Tsuchiura Kyodo Gen Hosp, Tsuchiura, Ibaraki, Japan

[15] Ajou Univ Hosp, Suwon, South Korea

[16] Univ Vermont, Coll Med, Fletcher Allen Healthcare, Div Cardiol, Burlington, VT USA

[17] Mayo Clin, Dept Internal Med, Div Cardiovasc Med, Rochester, MN USA

[18] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA

[19] LightLab Imaging Inc, St Jude Med, Westford, MA USA

[20] Mt Sinai Hosp, New York, NY 10029 USA

[21] Cardiovasc Pathol Inst, Gaithersburg, MD USA

关键词: acute coronary syndrome;    calcified nodule;    optical coherence tomography;    plaque erosion;    plaque rupture;   

DOI  :  10.1016/j.jacc.2013.05.071

来源: Elsevier

【 摘 要 】

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 OCTerosion 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 mu m vs. 60.4 +/- 16.6 mu m, p < 0.001), and smaller lipid arc (202.8 +/- 73.6 degrees vs. 275.8 +/- 60.4 degrees, 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 OCTerosion 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) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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