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Morphological characteristics of optical coherence tomography defined plaque fissure in patients with acute coronary syndrome

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Abstract

We assessed the plaque disruption in 245 consecutive patients with acute coronary syndrome undergoing percutaneous coronary intervention. The plaque fissure was diagnosed with optical coherence tomography, and intravascular ultrasound was used to determine arterial remodeling. Of them, 26 fissures were found in this study. The definite fissure was seen in 17 (65.4%) and probable fissure was seen in 9 (34.6%) patients. In 18 (69.2%), plaque fissure component was lipidic or thin-capped fibroatheroma. Eighteen (69.2%) of fissured plaque were seen within 30 mm of coronary ostium. Combined plaque fissure with plaque rupture/erosion was seen in 21 (80.8%) cases. The isolated fissure was seen in 5 (19.2%). Compared to the maximal necrotic core site of the ruptured plaque, the fissure site showed a smaller %necrotic core (p = 0.012), however, greater in fissure site than minimal lumen area site (24.93 ± 11.50% vs 15.34 ± 10.40%, p < 0.0001). The remodeling index was higher at fissure site as compared to minimal lumen area site (1.02 ± 0.22 vs 0.94 ± 0.27; p = 0.047), but similar to the rupture plaque (p = 0.31). The frequency of positive remodeling was 34.6% (9/26) at the plaque fissure. Although the plaque fissure can be interchangeable with the rupture in acute coronary syndrome, the limited extension to the small lipid core might and less positive remodeling provoke a fissuring of the plaque. Further study is necessary to assess the plaque fissure.

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Abbreviations

ACS:

Acute coronary syndrome

EEM:

External elastic membrane

ECG:

Electrocardiogram

IVUS:

Intravascular ultrasound

MLA:

Minimal lumen area

NSTEMI:

Non-ST elevation myocardial infarction

OCT:

Optical coherent tomography

PCI:

Percutaneous coronary intervention

P&M:

Plaque and media

QCA:

Quantitative coronary angiography

TIMI:

Thrombolysis in Myocardial Infarction

STEMI:

ST elevation myocardial infarction

PR:

Plaque rupture

PE:

Plaque erosion

TCFA:

Thin-capped fibroatheroma

VH-IVUS:

Virtual-Histology Intravascular Ultrasound

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Acknowledgements

The author thanks to YM Jo and DW Kang, researchers of Heart Research Institute, for their efforts to collect and review the cases, and KS Park, MPH, for her statistical assistance.

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  1. Sang Wook Kim and Wang Soo Lee equally contributed to this article as correspondence.

Authors and Affiliations

  1. Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea

    Mayank Goyal, Sang Wook Kim, Saima Sharmin, Hoyoun Won, Iksung Cho, Moon Ki Jung, Seung Yong Shin, Kwang Je Lee, Tae Ho Kim, Chee Jeong Kim & Wang Soo Lee

  2. All India Institute of Medical Science, New Delhi, India

    Sundeep Mishra

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  1. Mayank Goyal
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Correspondence to Sang Wook Kim or Wang Soo Lee.

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Goyal, M., Kim, S.W., Mishra, S. et al. Morphological characteristics of optical coherence tomography defined plaque fissure in patients with acute coronary syndrome. Heart Vessels 34, 427–434 (2019). https://doi.org/10.1007/s00380-018-1271-9

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  • DOI: https://doi.org/10.1007/s00380-018-1271-9

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