Eroded Versus Ruptured Plaques at the Culprit Site of STEMI

Abstract

In the present study, an IFC was observed at the culprit lesion site of one-third of STEMIs. IFC, compared with RFC, was associated with higher rates of patent IRA at first angiography, fewer lipid areas, and residual endoluminal thrombus. However, no difference in vascular response to everolimus-eluting stent was observed. (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty [OCTAVIA]; NCT01377207).

Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

“…The prevalence of STEMI was more frequent in patients with ruptured plaques than in those without, which was consistent with previous OCT studies [9,10,11]. The prevalence of preinfarction angina tended to be less frequent in ACS patients with ruptured plaques than in those without, which was also similar to a previous report [31].…”

“…However, we failed to show a difference in cardiac mortality between patients with and without ruptured plaques demonstrated by OCT, presumably because of the limited number of ACS patients who underwent OCT examination and the low incidence of cardiac death in the patients with OCT examinations. Previous OCT studies have also failed to show the impact of plaque rupture on cardiac death [10,11]. …”

“…To focus on the culprit plaque morphology in ACS patients, intracoronary imaging modalities such as intravascular ultrasound (IVUS) [2,3,4], coronary angioscopy [2] and optical coherence tomography (OCT) [5,6,7,8,9,10,11] are currently used. The high image resolution and accurate tissue characterization in OCT makes this method particularly superior for detecting ruptured plaques and thin-cap fibroatheroma (TCFA), which is regarded as a rupture-prone plaque.…”

Optical Coherence Tomography Guidance in Management of Acute Coronary Syndrome Caused by Plaque Erosion

“…41 Saia et al analyzed STEMI patients (divided into intact fibrous cap and ruptured fibrous cap groups) before and after PCI in 9 months; importantly, low levels of neointimal obstruction, high rates of strut coverage, and minimal rates of late malapposition were observed in the PE group. 42 Outcomes in Patients With PE and PR PE compared with PR shows different lesion severity, plaque features and thrombus composition that may lead to different outcomes. There is greater possibility for distal embolization in PE than with PR, because of the much longer existence of thrombus, 36 which is consistent with the report by Schwartz et al that there was an increase in microvascular occlusion downstream of PE compared with PR.…”

Empfehlungen zur Anwendung von intravaskulärer Bildgebung (optische Kohärenztomographie)

“…Nachdem bereits neuere histopathologische Daten nahegelegt hatten, dass das weitverbreitete pathophysiologische Verständnis, wonach eine Plaqueruptur ("ruptured fibrous cap", RFC) alleinige einem ACS zugrunde liegende Pathophysiologie ist [32], konnte mit der Plaqueerosion ("intact fibrous cap", IFC) eine weitere koronare Pathologie identifiziert werden, bei der es zu einer intrakoronaren Thrombusformation im Bereich eines strukturell intakten Endothels kommt [20,32]. In der OCTAVIAStudie lag bei rund einem Drittel aller ACS-Patienten mit ST-Hebungen eine Plaqueerosion (IFC-ACS) vor [33]. Die Plaqueerosionen scheinen v. a. im Bereich exzentrischer fibröser Plaques [34] aufzutreten und mit einer geringeren Thrombusformation und mikrovaskulä-ren Schäden vergesellschaftet zu sein, als dies bei RFC-ACS nachweisbar ist [35].…”