Elsevier

American Heart Journal

Volume 243, January 2022, Pages 66-76
American Heart Journal

Clinical Investigations
In vivo evidence of atherosclerotic plaque erosion and healing in patients with acute coronary syndrome using serial optical coherence tomography imaging

https://doi.org/10.1016/j.ahj.2021.09.007Get rights and content

Background

The EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) allowed us to observe the healing process of coronary plaque erosion in vivo. The present study aimed to investigate the incidence of newly formed healed plaque and different baseline characteristics of acute coronary syndrome (ACS) patients caused by plaque erosion with or without newly formed healed plaque using optical coherence tomography (OCT).

Methods

A total of 137 ACS patients with culprit plaque erosion who underwent pre-intervention OCT imaging and received no stent implantation were enrolled. Patients were stratified according to the presence or absence of newly formed healed phenotype at 1-month (137 patients) or 1-year OCT follow-up (52 patients). Patient's baseline clinical, angiographic, OCT characteristics and outcomes were compared.

Results

There were 55.5% (76/137) of patients developed healed plaque at 1 month, and 69.2% (36/52) of patients developed healed plaque at 1 year. Patients with newly formed healed plaque had larger thrombus burden, and lower degree of area stenosis (AS%) at baseline than those without, and thrombus burden and AS% were predictors of plaque healing. The healing process was accompanied by the significant increase of AS% and incidence of microchannels, and greater inflammatory response. The outcomes appeared to be similar between the two groups.

Conclusions

Newly formed healed plaque was found in more than half of ACS patients with plaque erosion without stenting. Patients with newly formed healed plaque had lower luminal stenosis and larger thrombus burden. During healing process, luminal stenosis increased gradually.

Section snippets

Study population

This study was a single-center observational study and was a retrospective analysis of 53 patients from the EROSION study and subsequent 84 patients with plaque erosion who met the inclusion criteria of EROSION and had OCT imaging for 1 month. Specifically, between October 2014 and July 2019, 11,704 ACS patients entered the screening procedure, of which 5,546 patients underwent pre-intervention OCT imaging, and 187 patients diagnosed as plaque erosion who did not receive coronary stent

Results

Among 137 patients completed 1-month OCT follow-up, 79 (57.7%) patients had healed plaque at baseline; 76 (55.5%) patients developed typical healed plaque; and 44 (32.1%) patients had healed plaque at baseline and newly formed healed plaque. In 52 patients completed 1-year OCT follow-up, 22 (42.3%) patients had healed plaque at baseline; 36 (69.2%) patients developed typical healed plaque; 17 (32.7%) patients had healed plaque at baseline and newly formed healed plaque (Figure 2).

Discussion

To the best of our knowledge, this is the first study in vivo investigating healing process of plaque erosion at the culprit site in the ACS population. The main findings of this study were (1) the prevalence of newly formed healed plaque was 55.5% at 1 month and 69.2% at 1 year; (2) as compared with patients without newly formed healed plaque, patients with newly formed healed plaque had larger thrombus burden, and lower degree of AS% at baseline, and AS% and thrombus burden were predictors of

Conclusions

Newly formed healed plaque was found in more than half of ACS patients with plaque erosion without stenting. Patients of plaque erosion with newly formed healed plaque had larger thrombus load and smaller lumen area stenosis than those without for baseline OCT characteristics, and coronary lumen narrowing aggravated with the progress of healing.

Author contributions

Yanwei Yin, Chao Fang, Senqing Jiang: the design of research, data acquisition analysis, and manuscript drafting; Jifei Wang, Yidan Wang, Junchen Guo, Fangmeng Lei, Sibo Sun, Xueying Pei, Ruyi Jia, Yini Wang: data acquisition; Lulu Li: statistical analysis; Huai Yu: patient enrollment and the perform of cardiac intervention; Jiannan Dai, Bo Yu: substantial contribution to the design of research and critical manuscript revision.

Financial support

This work was supported by the National Natural Science Foundation of China (No. 82072091 to J.D. and grant No. 81827806 to B.Y.), and Natural Science Foundation of Heilongjiang Province (YQ2020H017 to J.D.).

Conflicts of interest

None.

Acknowledgments

The authors sincerely thank all colleagues and patients who participated in this study.

References (27)

  • J Hou et al.

    Comparison of intensive versus moderate lipid-lowering therapy on fibrous cap and atheroma volume of coronary lipid-rich plaque using serial optical coherence tomography and intravascular ultrasound imaging

    Am J Cardiol

    (2016)
  • E Usui et al.

    Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography

    Atherosclerosis

    (2020)
  • GW Stone et al.

    A prospective natural-history study of coronary atherosclerosis

    N Engl J Med

    (2011)

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    These authors contributed equally to this work.

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