Culprit and Non-Culprit Plaque Characteristics With vs. Without a Healed Phenotype in Patients With Acute Myocardial Infarction Caused by Plaque Erosion　― A 3-Vessel OCT Study

• Published in: Circulation Journal Vol. 86; no. 5; pp. 846 - 854
• Main Authors: Yin, Yanwei, Fang, Chao, Jiang, Senqing, Wang, Jifei, Wang, Yidan, Guo, Junchen, Lei, Fangmeng, Sun, Sibo, Pei, Xueying, Jia, Ruyi, Tang, Caiying, Li, Lulu, Wang, Yini, Yu, Huai, Dai, Jiannan, Yu, Bo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.04.2022
• Subjects: Acute myocardial infarction; Coronary Angiography - methods; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Healed plaque; Humans; Myocardial Infarction - pathology; Optical coherence tomography; Phenotype; Plaque erosion; Plaque, Atherosclerotic - pathology; Tomography, Optical Coherence - methods; Healed plaque; Optical coherence tomography; Acute myocardial infarction; Plaque erosion
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-21-0635

Background: Plaque erosion can occur quietly without causing clinical symptoms, followed by a healing process resulting in healed plaque. This study aimed to assess culprit and non-culprit plaque characteristics of patients with acute myocardial infarction (AMI) caused by plaque erosion with vs. without healed phenotype at the culprit plaque using optical coherence tomography (OCT).Methods and Results: A total of 117 AMI patients caused by plaque erosion who underwent OCT imaging of 3 coronary arteries were included. Patients were divided into 2 groups based on presence or absence of a healed phenotype at the culprit site. Culprit and non-culprit plaque characteristics were compared between the 2 groups. A healed phenotype at the culprit lesion was identified in 47.9% of AMI patients caused by plaque erosion. Patients with a healed phenotype at the culprit site were more frequently with hyperlipidemia, and had a higher prevalence of macrophage infiltration, microchannels, cholesterol crystals, and calcification at the culprit lesion. Moreover, patients with a healed phenotype at the culprit site had more non-culprit plaques and more characteristics of plaque vulnerability at the non-culprit lesion. In addition, patients with a healed phenotype at the culprit site presented with more severe luminal stenosis at both the culprit and non-culprit lesion.Conclusions: A healed phenotype was identified in 47.9% of AMI patients caused by plaque erosion at the culprit site. A healed phenotype within eroded culprit plaque was associated with signs of pancoronary vulnerability and advanced atherosclerosis.