Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study

Weng, Ziqian; Zhao, Chen; Qin, Yuhan; Liu, Chun Yu; Pan, Weili; Hu, Sining; He, Luping; Xu, Yiyue; Zeng, Ming; Feng, Xue; Gao, Rui; Yu, Xianghao; Liu, Minghao; Yi, Boling; Zhang, Dirui; Koniaeva, Ekaterina; Musin, Timur Ilgamovich; Mohammad, Dahlia Abdal Hameed Abdal Magid; Zhu, Bo; Sun, Ying; Hou, Jingbo; Tian, Jie; Mintz, Gary S.; Jia, Haibo; Yu, Bo

doi:10.1016/j.ahj.2023.06.006

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…Last but not least, patients with PE frequently exhibit less extensive non-coronary atherosclerosis compared to PR as evidenced by peripheral plaque prevalence (79.1% vs. 93.4%, p < 0.001), as well as a lower number of peripheral atherosclerotic plaques [ 38 ]. Characteristics of peripheral lesion vulnerability (surface irregularity, plaque heterogeneity, and calcification) are also less commonly seen in patients with ACS caused by PE [ 38 ].…”

Section: Plaque Phenotypesmentioning

confidence: 99%

Coronary Plaque Erosion: Epidemiology, Diagnosis, and Treatment

Theofilis,

Vlachakis,

Papanikolaou

et al. 2024

IJMS

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Plaque erosion (PE), a distinct etiology of acute coronary syndromes (ACSs), is often overshadowed by plaque ruptures (PRs). Concerning its epidemiology, PE has garnered increasing recognition, with recent studies revealing its prevalence to be approximately 40% among ACS patients, challenging earlier assumptions based on autopsy data. Notably, PE exhibits distinct epidemiological features, preferentially affecting younger demographics, particularly women, and often manifesting as a non-ST-segment elevation myocardial infarction. There are seasonal variations, with PE events being less common in winter, potentially linked to physiological changes and cholesterol solidification, while peaking in summer, warranting further investigation. Moving to molecular mechanisms, PE presents a unique profile characterized by a lesser degree of inflammation compared to PR, with endothelial shear stress emerging as a plausible molecular mechanism. Neutrophil activation, toll-like receptor-2 pathways, and hyaluronidase 2 expression are among the factors implicated in PE pathophysiology, underscoring its multifactorial nature. Advancements in intravascular imaging diagnostics, particularly optical coherence tomography and near-infrared spectroscopy coupled with intravascular ultrasound, offer unprecedented insights into plaque composition and morphology. Artificial intelligence algorithms show promise in enhancing diagnostic accuracy and streamlining image interpretation, augmenting clinician decision-making. Therapeutically, the management of PE evolves, with studies exploring less invasive approaches such as antithrombotic therapy without stenting, particularly in cases identified early through intravascular imaging. Additionally, the potential role of drug-coated balloons in reducing thrombus burden and minimizing future major adverse cardiovascular events warrants further investigation. Looking ahead, the integration of advanced imaging modalities, biomarkers, and artificial intelligence promises to revolutionize the diagnosis and treatment of coronary PE, ushering in a new era of personalized and precise cardiovascular care.

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Section: Plaque Phenotypesmentioning

confidence: 99%

Coronary Plaque Erosion: Epidemiology, Diagnosis, and Treatment

Theofilis,

Vlachakis,

Papanikolaou

et al. 2024

IJMS

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“…Nowadays, it is believed that acute plaque destabilization is not entirely a local event, but it reflects a generalized high risk for acute cardiovascular events [ 8 ]. Many researchers have used the term “vulnerable patient”, defined as a patient with established atherosclerosis throughout the artery tree, who clusters a number of cardiovascular risk factors, traditional and novel, further precipitating plaque vulnerability and exaggerating the overall cardiovascular risk [ 9 , 10 ]. The presence of calcification at any arterial district may predict atherosclerosis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Novel Biomarkers and Imaging Indices for the “Vulnerable Patient” with Carotid Stenosis: A Single-Center Study

Kadoglou,

Moulakakis,

Mantas

et al. 2023

Biomolecules

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Background: We investigated the relationship of matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score with the severity and vulnerability of carotid atherosclerosis and major adverse cardiovascular events (MACE) during follow-up of carotid artery revascularization. Methods: We enrolled 262 patients undergoing carotid revascularization therapy (GRT), 109 asymptomatic patients with low-grade carotid stenosis (40–70%) receiving conservative treatment (GCT), and 92 age- and sex-matched control subjects without carotid atherosclerosis (GCO). All participants underwent carotid ultrasound and we assessed at baseline clinical parameters, metabolic profile, CAVI, GSM, and circulating levels of hsCRP, MMP-3,-7,-9, and TIMP-1. Results: Both GRT and GCT presented with elevated CAVI, MMPs, and TIMP-1 levels compared to GCO (p < 0.001). The escalation highly correlated to the presence of symptoms or paralleled the degree of carotid stenosis (p < 0.001). During follow-up (mean duration: 55 months), 51 GRT patients experienced MACE unrelated to the revascularization procedure. Within GRT, diabetes (HR: 2.07; CI: 1.55–2.78, p < 0.001), smoking (HR: 1.67; CI: 1.35–1.95, p < 0.001), high CAVI (HR: 1.22; CI: 1.09–1.43, p = 0.023) and MMP-9 (HR: 1.44; CI: 1.29–2.15, p = 0.005), and low GSM (HR: 1.40; CI: 1.16–2.12, p = 0.002) independently predicted MACE occurrences, despite the optimum medical therapy. Conclusions: Novel imaging and biochemical biomarkers were positively associated with atherosclerosis severity, while CAVI, MMP-9, and low GSM showed a positive, independent relationship with MACE after carotid revascularization, describing “vulnerable patients”.

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Comparison and identification of human coronary plaques with/without erosion using patient-specific optical coherence tomography-based fluid–structure interaction models: a pilot study

Zhu,

Zhao,

et al. 2024

Biomech Model Mechanobiol

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Plaque erosion (PE) with secondary thrombosis is one of the key mechanisms of acute coronary syndrome (ACS) which often leads to drastic cardiovascular events. Identification and prediction of PE are of fundamental significance for disease diagnosis, prevention and treatment. In vivo optical coherence tomography (OCT) data of eight eroded plaques and eight non-eroded plaques were acquired to construct three-dimensional fluid–structure interaction models and obtain plaque biomechanical conditions for investigation. Plaque stenosis severity, plaque burden, plaque wall stress (PWS) and strain (PWSn), flow shear stress (FSS), and ΔFSS (FSS variation in time) were extracted for comparison and prediction. A logistic regression model was used to predict plaque erosion. Our results indicated that the combination of mean PWS and mean ΔFSS gave best prediction (AUC = 0.866, 90% confidence interval (0.717, 1.0)). The best single predictor was max ΔFSS (AUC = 0.819, 90% confidence interval (0.624, 1.0)). The average of maximum FSS values from eroded plaques was 76% higher than that from the non-eroded plaques (127.96 vs. 72.69 dyn/cm2) while the average of mean FSS from erosion sites of the eight eroded plaques was 48.6% higher than that from sites without erosion (71.52 vs. 48.11 dyn/cm2). The average of mean PWS from plaques with erosion was 22.83% lower than that for plaques without erosion (83.2 kPa vs. 107.8 kPa). This pilot study suggested that combining plaque stress, strain and flow shear stress could help better identify patients with potential plaque erosion, enabling possible early intervention therapy. Further studies are needed to validate our findings.

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Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study

Cited by 6 publications

References 32 publications

Coronary Plaque Erosion: Epidemiology, Diagnosis, and Treatment

Coronary Plaque Erosion: Epidemiology, Diagnosis, and Treatment

Novel Biomarkers and Imaging Indices for the “Vulnerable Patient” with Carotid Stenosis: A Single-Center Study

Comparison and identification of human coronary plaques with/without erosion using patient-specific optical coherence tomography-based fluid–structure interaction models: a pilot study

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