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Research Article | Open Access

Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients: an optical coherence tomography study

Wei-Jun YIN, Jing JING, Ying-Qian ZHANG, Feng TIAN, Tao ZHANG, Shan-Shan ZHOU, Yun-Dai CHEN()
Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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Abstract

BACKGROUND

Healed plaques are frequently found in patients with acute coronary syndrome, but the prognostic value is debatable. This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography (OCT) with the aim of predicting plaque progression of healed plaques.

METHODS

This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT imaging and follow-up angiography from January 2015 to December 2019. Plaque progression predictors were assessed by multivariate analysis.

RESULTS

Among 113 non-culprit lesions, 27 healed plaques (23.9%) were identified. Patients with non-culprit healed plaques had prior antiplatelet therapy (65.0% vs. 33.8%, P = 0.019), hypertension (85.0% vs. 50.7%, P = 0.009), and dyslipidemia (70.0% vs. 41.5%, P = 0.04) which were more frequently than those without healed plaques. The thickness (r = 0.674, P < 0.001), arc (r = 0.736, P < 0.001), and volume (r = 0.541, P = 0.004) of healed plaque were correlated with minimum lumen diameter changes. At a mean follow-up of 11.5 months, the non-culprit healed plaques had a lower minimum lumen diameter (1.61 ± 0.46 mm vs. 1.91 ± 0.73 mm, P = 0.016), lower average lumen diameter (1.86 mm vs. 2.10 mm, P = 0.033), and a higher degree of diameter stenosis (41.4% ± 11.9% vs. 35.5% ± 13.1%, P = 0.031) when compared to baseline measurements. The plaque progression rate was higher in the healed plaque group (33.3% vs. 8.1%, P = 0.002), and multivariate analysis identified healed plaques [odds ratio (OR) = 8.49, 95% CI: 1.71−42.13] and lumen thrombus (OR = 10.69, 95% CI: 2.21−51.71) as predictors of subsequent lesion progression.

CONCLUSIONS

Healed plaques were a predictor for rapid plaque progression. The quantitative parameters of healed plaque showed a good agreement with plaque progression. Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol. Bifurcation lesions might be the predilection sites of healed plaques.

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Journal of Geriatric Cardiology
Volume 18 Issue 8,
August 2021
Pages 631-644
DOI: 10.11909/j.issn.1671-5411.2021.08.001
Cite this article:
YIN W-J, JING J, ZHANG Y-Q, et al. Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients: an optical coherence tomography study. Journal of Geriatric Cardiology, 2021, 18(8): 631-644. https://doi.org/10.11909/j.issn.1671-5411.2021.08.001
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Clinical characteristics of the patients.

Patient levelPatients with non-culprit healed plaque (n = 20)Patients without non-culprit healed plaque (n = 65)P−value
Data are presented as means ± SD or n (%). *Presented as median (interquartile range). AA: arachidonic acid; ADP: adenosine diphosphate; DBP: diastolic blood pressure; HbA1c: glycated haemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; NSTE-ACS: non-ST-segment elevation acute coronary syndrome; SBP: systolic blood pressure; STEMI: ST-segment elevation myocardial infarction.
Follow-up period, month 14.0 (9.5−15.0)* 11.0 (7.8−15.3)* 0.12
Age, yrs 59.5 ± 8.6 58.2 ± 9.6 0.98
Male sex 11 (55.0%) 48 (73.8%) 0.11
Body mass index, kg/m2 25.9 ± 3.0 24.9 ± 3.5 0.25
Mean SBP, mmHg 131.4 ± 19.0 130.6 ± 15.5 0.78
Mean DBP, mmHg 74.4 ± 13.2 74.1 ± 11.2 0.93
Mean heart rates, beat/min 74.4 ± 9.0 72.2 ± 11.1 0.42
Hypertension 17 (85.0%) 33 (50.7%) < 0.05
Antihypertensive therapy 14 (70.0%) 30 (46.2%) 0.07
Diabetes mellitus 7 (35.0%) 26 (40.0%) 0.79
Hypoglycemic treatment 6 (30.0%) 23 (35.4%) 0.79
Dyslipidemia 14 (70.0%) 27 (41.5%) < 0.05
Statins therapy 1 (5.0%) 2 (3.1%) 0.68
Current smoking 8 (40.0%) 23 (35.4%) 0.79
Prior myocardial infarction 4 (20.0%) 10 (15.4%) 0.73
Prior percutaneous coronary intervention 3 (15.0%) 18 (27.7%) 0.38
Prior antiplatelet therapy 13 (65.0%) 22 (33.8%) < 0.05
Cerebrovascular or peripheral diseases 11 (55.0%) 20 (30.8%) 0.06
Clinical presentation 0.68
　STEMI 1 (5.0%) 8 (12.3%) −
　NSTE-ACS 19 (99.5%) 57 (87.7%) −
Left ventricular ejection fraction, % 58.0 ± 9.3 59.1 ± 8.2 0.61
Laboratory data on admission
　Total cholesterol, mg/dL 158.3 ± 33.6 144.9 ± 41.3 0.19
　LDL-C, mg/dL 101.3 ± 32.4 81.8 ± 32.9 < 0.05
　HDL-C, mg/dL 46.0 ± 15.2 38.1 ± 17.0 0.098
　Triglyceride, mg/dL 109.4 (81.7−152.3)* 127.9 (106.1−179.4)* 0.58
　Hemoglobin, g/L 130.8 ± 17.7 133.3 ± 22.5 0.65
　Hypersensitive C-creative protein, mg/dL 0.21 (0.10−0.47)* 0.10 (0.05−0.13)* < 0.05
　HbA1c, % 6.5 ± 1.4 6.6 ± 1.4 0.73
　Uric acid, μmol/L 351.5 ± 122.6 328.9 ± 86.1 0.36
　Creatinine clearance, mL/min per 1.73 m2 87.2 ± 31.4 92.7 ± 31.8 0.49
　Coagulation index −1.2 ± 1.7 −1.0 ± 2.3 0.81
　Platelet inhibition ratio (ADP), % 72.1 (49.7−92.2)* 78.6 (56.6−90.2)* 0.48
　Platelet inhibition ratio (AA), % 93.1 (87.7−95.7)* 91.4 (72.4−96.7)* 0.98
Medication out of hospital
　Aspirin 19 (95.0%) 65 (100.0%) 0.24
　Clopidogrel 17 (85.0%) 29 (44.6%) < 0.05
　Ticagrelor 4 (20.0%) 35 (53.8%) < 0.05
Clinical presentation at follow-up 0.11
　STEMI 0 1 (1.5%)
　NSTE-ACS 9 (18.0%) 17 (26.2%)
　Stable angina 1 (5.0%) 1 (1.5%)
　No symptoms 10 (50.0%) 46 (70.8%)
Risk factors at follow-up
　Mean SBP, mmHg 131.40 ± 17.2 128.35 ± 17.1 0.54
　Mean DBP, mmHg 76.3 ± 10.2 74.2 ± 9.0 0.44
　LDL-C, mg/dL 82.1 ± 29.8 59.9 ± 20.5 < 0.05
　LDL-C under control, mg/dL 9 (45.0%) 40 (61.5%) 0.79
　Quit smoking 19 (95.0%) 63 (96.9%) 1.00
　HbA1c, % 6.1 (5.9−7.2)* 6.2 (5.7−7.1)* 0.38

Angiographic parameters.

Lesion levelLesions with non-culprit healed plaque (n = 27)Lesions with non-culprit non-healed plaque (n = 86)P-value
Data are presented as means ± SD or n (%).
Lesion location 0.25
　Left main artery 1 (3.7%) 1 (1.2%)
　Left anterior descending artery 18 (66.7%) 53 (61.7%)
　Right coronary artery 7 (25.9%) 18 (20.9%)
　Left circumflex artery 1 (3.7%) 14 (16.3%)
Distribution 0.79
　Proximal 9 (33.3%) 22 (25.6%)
　Middle 5 (18.5%) 32 (37.2%)
　Distal 13 (48.2%) 32 (37.2%)
Baseline
　Lesion length, mm 8.56 ± 3.67 8.19 ± 4.03 0.72
　Reference diameter, mm 2.71 ± 0.52 2.90 ± 0.89 0.14
　Minimum lumen diameter, mm 1.92 ± 0.46 2.07 ± 0.73 0.19
　Average lumen diameter, mm 2.48 ± 0.45 2.59 ± 0.75 0.42
　Diameter stenosis, % 29.1 ± 9.9 29.1 ± 11.5 0.95
Follow-up
　Lesion length, mm 9.05 ± 3.88 8.43 ± 4.01 0.47
　Reference diameter, mm 2.74 ± 0.52 2.65 ± 0.72 0.61
　Minimum lumen diameter, mm 1.61 ± 0.46 1.91 ± 0.73 < 0.05
　Average lumen diameter, mm 1.86 ± 0.43 2.10 ± 0.70 < 0.05
　Diameter stenosis, % 41.4 ± 11.9 35.5 ± 13.1 < 0.05
Comparison
　Decrease in minimum lumen diameter 0.31 ± 0.25 0.17 ± 0.15 < 0.001
　Plaque progression 9 (33.3%) 7 (8.1%) 0.002

Optical coherence tomography findings.

Lesion levelLesions with non-culprit healed plaque (n = 27)Lesions with non-culprit non-healed plaque (n = 86)P-value
Data are presented as means ± SD or n (%). *Presented as median (interquartile range).
Lesion length, mm 8.6 ± 3.2 8.7 ± 3.5 0.79
Plaque type < 0.05
　Fibrous plaque 2 (7.4%) 26 (30.2%)
　Lipid plaque 25 (92.6%) 60 (69.8%)
　　Thinnest fibrous cap thickness, mm 64.0 (55.5−171.5)* 110.5 (61.0−156.0)* 0.46
　　Lipid length, mm 8.00 (5.37−9.66)* 7.80 (6.48−9.00)* 0.72
　　Maximum lipid arc, ° 194.1 ± 61.3 152.6 ± 44.0 < 0.001
　　Mean lipid arc, ° 129.43 ± 31.74 101.25 ± 32.05 < 0.05
　　Lipid index, mm 984.34 (543.88−1481.86)* 732.84 (553.55−1105.86)* < 0.05
Thin-cap fibroatheroma 13 (48.1%) 27 (31.4%) 0.16
Lipid-rich plaque 18 (66.7%) 34 (39.5%) < 0.05
Plaque rupture 12 (44.4%) 23 (26.7%) < 0.05
Lumen thrombus 4 (14.8%) 11 (12.8%) 0.75
Macrophage accumulation 23 (85.2%) 53 (61.6%) < 0.05
Cholesterol crystal 5 (18.5%) 9 (10.5%) 0.77
Microvessels 10 (37.0%) 35 (40.7%) 0.91
Bifurcation 13 (48.1%) 20 (23.2%) < 0.05
Calcification 12 (44.4%) 46 (53.4%) 0.41
Calcification score 0.7 ± 1.2 0.6 ± 1.1 0.91
Spotty calcification 3 (11.1%) 21 (24.4%) 0.15
Minimum lumen area, mm2 4.31 ± 2.05 4.60 ± 2.75 0.57
Reference area, mm2 7.56 ± 2.80 6.49 ± 3.29 0.96
Area stenosis, % 41.95 ± 17.67 40.30 ± 16.98 0.51

Predictors of plaque progression.

Univariate analysisMultivariate analysis
Odds ratio95% CIP-valueOdds ratio95% CIP-value
Healed plaque 4.85 1.45−16.17 < 0.05 8.49 1.71−42.13 < 0.05
Bifurcation 2.47 0.14−1.18 0.096 1.90 0.7−5.04 0.19
Thin-cap fibroatheroma 3.07 1.25−7.50 < 0.05 2.11 0.62−7.19 0.23
Rupture 4.83 1.67−13.97 < 0.05 1.03 0.30−3.52 0.96
Macrophage 2.61 0.82−8.23 0.10 0.69 0.12−4.16 0.69
Lumen thrombus 7.32 2.04−26.35 < 0.05 10.69 2.21−51.7 < 0.05
Cholesterol crystal 1.04 0.32−3.31 0.95
Microvessels 0.91 0.31−2.74 0.87
Spotty calcification 0.46 0.09−2.19 0.33