JACC Focus Seminar: Optical Coherence Tomography Studies in Coronary Atherosclerosis
JACC Focus Seminar
Optical Coherence Tomography of Plaque Erosion: JACC Focus Seminar Part 2/3

https://doi.org/10.1016/j.jacc.2021.07.030Get rights and content
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Highlights

  • Plaque erosion, a distinct histopathological and clinical entity, accounts for over 30% of cases of ACS.

  • Available evidence suggests that in patients with ACS and plaque erosion, antithrombotic therapy without stenting may be a safe and effective therapeutic option, but confirmation will require evidence from randomized trials.

  • Future research should address novel therapeutic strategies that target the molecular pathways involved in plaque erosion.

Abstract

Plaque erosion, a distinct histopathological and clinical entity, accounts for over 30% of acute coronary syndromes (ACS). Optical coherence tomography allows in vivo diagnosis of plaque erosion. Local flow perturbation with activation of Toll-like receptor 2 and CD8+ T cells and subsequent desquamation of endothelium and neutrophil extracellular trap formation contribute to mechanisms of plaque erosion. Compared with ACS patients with plaque rupture, those with plaque erosion are younger, have fewer traditional cardiovascular risk factors, have lower plaque burden, and are more likely to present with non–ST-segment elevation ACS. Early evidence suggests that in patients with ACS caused by plaque erosion, antithrombotic therapy without stenting may be a safe and effective option. Future randomized trials are needed to validate these findings. Clinical studies to develop noninvasive point-of-care biomarkers that distinguish plaque rupture from erosion, and to test novel therapies that target molecular pathways involved in plaque erosion are needed.

Key Words

acute coronary syndromes
coronary thrombosis
erosion
optical coherence tomography
plaque

Abbreviations and Acronyms

ACS
acute coronary syndrome
CI
confidence interval
ESS
endothelial shear stress
IHD
ischemic heart disease
MPO
myeloperoxidase
NET
neutrophil extracellular trap
NSTE-ACS
non–ST-segment elevation acute coronary syndrome
OCT
optical coherence tomography
OR
odds ratio
SCD
sudden cardiac death
STEMI
ST-segment elevation myocardial infarction

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Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

David X. Zhao, MD, served as Guest Associate Editor for this paper.

Javed Butler, MD, MPH, MBA, served as Guest Editor-in-Chief for this paper.

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