Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes

Background Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti‐thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST‐segment elevation‐ACS than in ST‐segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age <68 years, anterior ischemia, no diabetes mellitus, hemoglobin >15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST‐segment elevation‐ACS, the probability of plaque erosion increased to 73.1%. Conclusions Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of ACS patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03479723.

[1]  P. Barlis,et al.  Endothelial Shear Stress and Plaque Erosion: A Computational Fluid Dynamics and Optical Coherence Tomography Study. , 2019, JACC. Cardiovascular imaging.

[2]  F. Prati,et al.  Innovative invasive management without stent implantation guided by optical coherence tomography in acute coronary syndrome. , 2018, Archives of cardiovascular diseases.

[3]  G. Mintz,et al.  In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study , 2018, European heart journal.

[4]  Hang Lee,et al.  Thrombus resolution with tirofiban in the conservative management of patients presenting with plaque erosion , 2018, Coronary artery disease.

[5]  Yingchun Zhu,et al.  EROSION Study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) A 1-Year Follow-Up Report , 2017, Circulation. Cardiovascular interventions.

[6]  P. Libby,et al.  Flow Perturbation Mediates Neutrophil Recruitment and Potentiates Endothelial Injury via TLR2 in MiceNovelty and Significance , 2017 .

[7]  Hang Lee,et al.  Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study) , 2016, European heart journal.

[8]  A. Newby,et al.  Endothelial erosion of plaques as a substrate for coronary thrombosis , 2016, Thrombosis and Haemostasis.

[9]  T. Kakuta,et al.  Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography. , 2016, International journal of cardiology.

[10]  Jeroen J. Bax,et al.  2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). , 2011, European heart journal.

[11]  Baris Gencer,et al.  ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation , 2011 .

[12]  Masahiro Yamada,et al.  A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction: Incidence, Morphologic Characteristics, and Outcomes After Percutaneous Coronary Intervention. , 2015, JACC. Cardiovascular interventions.

[13]  P. Libby,et al.  TLR2 and neutrophils potentiate endothelial stress, apoptosis and detachment: implications for superficial erosion. , 2015, European heart journal.

[14]  A. M. Leone,et al.  Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome. , 2015, European heart journal.

[15]  P. Serruys,et al.  Reversal of flow between serial bifurcation lesions: insights from computational fluid dynamic analysis in a population-based phantom model. , 2015, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[16]  A. Jaffe,et al.  A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines , 2015 .

[17]  Bo Yu,et al.  In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. , 2013, Journal of the American College of Cardiology.

[18]  D. Ku,et al.  Platelet transport rates and binding kinetics at high shear over a thrombus. , 2013, Biophysical journal.

[19]  Erling Falk,et al.  Update on acute coronary syndromes: the pathologists' view. , 2013, European heart journal.

[20]  V. Fuster,et al.  OCT-based diagnosis and management of STEMI associated with intact fibrous cap. , 2013, JACC. Cardiovascular imaging.

[21]  Jennifer G. Robinson,et al.  ACCF/AHA TASK FORCE MEMBERS , 2013 .

[22]  R. Yeh,et al.  Nonculprit Plaques in Patients With Acute Coronary Syndromes Have More Vulnerable Features Compared With Those With Non–Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study , 2012, Circulation. Cardiovascular imaging.

[23]  Akiko Maehara,et al.  Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. , 2012, Journal of the American College of Cardiology.

[24]  R. Polosa,et al.  Circulating endothelial‐coagulative activation markers after smoking cessation: a 12‐month observational study , 2011, European journal of clinical investigation.

[25]  Y. Kihara,et al.  Increased leukocyte rho kinase (ROCK) activity and endothelial dysfunction in cigarette smokers , 2010, Hypertension Research.

[26]  F. Sofi,et al.  Comparison of hemorheological variables in ST-elevation myocardial infarction versus those in non-ST-elevation myocardial infarction or unstable angina pectoris. , 2008, The American journal of cardiology.

[27]  Takashi Akasaka,et al.  Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. , 2007, Journal of the American College of Cardiology.

[28]  Brett E. Bouma,et al.  In Vivo Characterization of Coronary Atherosclerotic Plaque by Use of Optical Coherence Tomography , 2005, Circulation.

[29]  E. Halpern,et al.  Characterization of Human Atherosclerosis by Optical Coherence Tomography , 2002, Circulation.

[30]  R. Virmani,et al.  Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[31]  R. Marchant,et al.  Shear-dependent changes in the three-dimensional structure of human von Willebrand factor. , 1996, Blood.

[32]  J. Morrow,et al.  Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. , 1995, The New England journal of medicine.

[33]  J. Murray,et al.  Biochemical evidence of a chronic abnormality in platelet and vascular function in healthy individuals who smoke cigarettes. , 1987, Circulation.