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Predictors for layered coronary plaques: an optical coherence tomography study.

Makoto Araki1,2, Taishi Yonetsu3, Michele Russo1

  • 1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA.

Journal of Thrombosis and Thrombolysis
|April 20, 2020
PubMed
Summary

Stable angina pectoris (SAP) is a key predictor of layered coronary plaques, indicating previous plaque disruption. These findings highlight factors associated with vascular vulnerability in coronary artery disease.

Keywords:
Healed plaqueLayered plaqueOptical coherence tomographyPredictorStable angina pectoris

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Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Pathology

Background:

  • Layered plaques, identified by optical coherence tomography (OCT), signify prior coronary plaque disruption and healing.
  • Layered plaques are linked to increased vascular vulnerability, but their predictors remain unstudied.

Purpose of the Study:

  • To identify predictors of layered plaques in both culprit and non-culprit coronary lesions.
  • To investigate the clinical and morphological factors associated with the presence of layered plaques.

Main Methods:

  • Retrospective analysis of 313 patients with coronary artery disease undergoing pre-intervention OCT imaging.
  • Layered plaques defined by distinct layers of varying optical density on OCT.
  • Multivariable regression analysis to determine independent predictors for layered plaques.

Main Results:

  • Layered plaque prevalence varied by clinical presentation: 18.8% in ST-segment elevation myocardial infarction, 36.3% in non-ST-segment elevation acute coronary syndrome, and 53.4% in stable angina pectoris (SAP).
  • Independent predictors for culprit lesion layered plaque included SAP, multivessel disease, B2/C lesion type, and >70% diameter stenosis.
  • For non-culprit lesions, SAP and culprit lesion characteristics (thin-cap fibroatheroma, layered plaque) predicted layered plaque formation.

Conclusions:

  • Stable angina pectoris is a significant independent predictor for layered plaques in both culprit and non-culprit coronary lesions.
  • The development of layered plaques may reflect a complex interplay between systemic vascular vulnerability and the body's protective mechanisms.