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Differences in total plaque burden between plaque rupture and plaque erosion: A combined computed tomography
Takayuki Niida1, Eisuke Usui2, Keishi Suzuki1
1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Patients with plaque rupture have significantly greater total plaque burden, including non-calcified and calcified plaque, compared to those with plaque erosion. This finding highlights differences in atherosclerotic disease in acute coronary syndromes.
Area of Science:
- Cardiology
- Radiology
- Pathology
Background:
- Coronary computed tomography angiography (CTA) assesses atherosclerotic plaque burden.
- No prior studies linked culprit lesion pathology to total plaque burden in acute coronary syndromes.
Purpose of the Study:
- To compare total plaque burden between patients with plaque rupture versus plaque erosion.
Main Methods:
- 232 patients with first non-ST-segment elevation acute coronary syndrome underwent CTA and optical coherence tomography.
- Semi-automated software quantified plaque burden, defining low-density non-calcified plaque (LDNCP) <30 Hounsfield units.
- Coronary arteries assessed using the modified 17-segment American Heart Association model.
Main Results:
- Plaque rupture occurred in 125 patients (53.9%), plaque erosion in 107 (46.1%).
- Significantly greater total plaque burden (48.2% vs 44.1%), non-calcified plaque (NCP) burden (46.6% vs 43.0%), LDNCP burden (2.3% vs 1.7%), and calcified plaque (CP) burden (0.8% vs 0.4%) were observed in plaque rupture vs. erosion groups.
- All comparisons showed statistical significance (P < 0.05).
Conclusions:
- Patients with plaque rupture exhibit a greater total plaque burden, NCP, LDNCP, and CP burden compared to those with plaque erosion.
- These findings suggest distinct plaque characteristics based on underlying pathology in acute coronary syndromes.
Backgrounds:
Coronary computed tomography angiography (CTA) allows for the assessment of atherosclerotic plaque burden across the entire coronary vasculature. No studies have examined the relationship between the underlying pathology of the culprit lesion and total plaque burden in patients with acute coronary syndromes. The aim of this study was to compare the total plaque burden between patients with plaque rupture versus plaque erosion.
Methods:
A total of 232 patients who presented with their first non-ST-segment elevation acute coronary syndrome and underwent both CTA and optical coherence tomography imaging before intervention were selected. Quantitative analysis was performed using semi-automated software (Autoplaque version 3.0, Cedars-Sinai Medical Center). An attenuation of <30 Hounsfield units defined low-density non-calcified plaque (LDNCP). All 3 vessels were assessed using the modified 17-segment American Heart Association model for coronary segment classification.
Results:
Among 232 patients, 125 (53.9%) had plaque rupture and 107 (46.1%) had plaque erosion. Total plaque burden (48.2 [39.8-54.9] % vs. 44.1 [38.6-50.0] %, P = 0.006), total non-calcified plaque (NCP) burden (46.6 [39.1-53.3] % vs. 43.0 [37.6-49.2] %, P = 0.013), total LDNCP burden (2.3 [1.4-3.0] % vs. 1.7 [1.2-2.6] %, P = 0.016), and total calcified plaque (CP) burden (0.8 [0.1-1.6] % vs. 0.4 [0.0-1.4] %, P = 0.047) were significantly greater in patients with culprit plaque rupture than in those with culprit plaque erosion.
Conclusion:
Patients with plaque rupture, compared with those with plaque erosion, had a greater total plaque burden, NCP burden, LDNCP burden, and CP burden.
Clinical Trial Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT04523194.
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