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Relation Between Superficial Calcifications and Plaque Rupture: An Optical Coherence Tomography Study.

Yefei Zhan1, Yingying Zhang2, Jingbo Hou2

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Thin calcification depth (CAL-DEP) in lipid-rich plaques is a key indicator of vulnerable coronary artery plaques prone to rupture in acute coronary syndrome (ACS). A CAL-DEP of 63 μm or less signifies critical vulnerability.

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Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Pathology of Atherosclerosis

Background:

  • Coronary artery calcification plays a complex role in plaque stability.
  • The relationship between specific calcification morphology and lipid-rich lesion rupture in acute coronary syndrome (ACS) remains unclear.

Purpose of the Study:

  • To investigate whether calcification depth (CAL-DEP) in lipid-rich plaques is associated with lesion rupture in ACS patients.
  • To identify morphological characteristics of vulnerable plaques using optical coherence tomography (OCT).

Main Methods:

  • Retrospective analysis of 78 ACS patients with lipid-rich, calcified culprit lesions identified via preintervention OCT imaging.
  • Measurement of the smallest calcium depth (CAL-DEP) and analysis of plaque morphology.
  • Comparison of CAL-DEP between ruptured and non-ruptured lipid-rich lesions.

Main Results:

  • Ruptured lesions exhibited significantly thinner CAL-DEP (median 50 μm) compared to non-ruptured lesions (median 110 μm; P < 0.001).
  • Thinner CAL-DEP was also observed in myocardial infarction patients versus unstable angina patients (P=0.045).
  • A CAL-DEP < 63 μm accurately predicted lipid-rich lesion rupture (sensitivity 77.8%, specificity 81.8%).

Conclusions:

  • Thin CAL-DEP (< 63 μm) in lipid-rich calcified plaques is a morphological marker of plaque vulnerability.
  • This critical depth identifies plaques at high risk for rupture in ACS patients.