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OCT-based comparative evaluation of culprit lesion morphology in very young versus older adult patients with STEMI
M P Girish1, Mohit D Gupta1, Akiko Maehara2,3
1Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
Insights
Plaque erosion is a more common cause of ST-segment elevation myocardial infarction (STEMI) in young adults, while plaque rupture is more frequent in older adults. Plaque erosion is associated with subacute thrombus, unlike plaque rupture which is linked to acute thrombus.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Coronary artery disease (CAD) in young adults presents unique clinical and pathophysiological challenges.
- Understanding the specific mechanisms of myocardial infarction in younger populations is crucial for targeted treatment strategies.
Purpose of the Study:
- To compare the culprit lesion morphology in very young adults (≤35 years) versus older adults (>60 years) with ST-segment elevation myocardial infarction (STEMI).
- To investigate the underlying mechanisms of STEMI using optical coherence tomography (OCT).
Main Methods:
- Optical coherence tomography (OCT) was employed to analyze culprit lesion morphology in STEMI patients.
- Lesions were categorized as plaque rupture, plaque erosion, or calcified nodule.
- Thrombus age was classified as acute or subacute based on morphological characteristics.
Main Results:
- Plaque erosion was significantly more prevalent in very young patients (52.6%) compared to older patients (21.7%) (p=0.02).
- Plaque rupture was more common in older patients (65.2%) than in very young patients (36.8%) (p=0.03).
- Subacute thrombus was more frequently observed in patients with plaque erosion (52.0%) compared to plaque rupture (10.3%) (p=0.0008).
Conclusions:
- Plaque erosion and plaque rupture are the primary underlying mechanisms for STEMI in very young and older adult patients, respectively.
- OCT imaging provides valuable insights into the differences in lesion morphology and thrombus characteristics between age groups.
- Findings highlight distinct pathophysiological pathways for STEMI in different age demographics, informing future research and clinical practice.
Background:
The clinical and pathophysiological characteristics of coronary artery disease in very young adults are poorly described.
Aims:
Using optical coherence tomography (OCT), we compared culprit lesion morphology in very young adult patients (≤35 years) versus older adult patients (>60 years) with ST-segment elevation myocardial infarction (STEMI).
Methods:
Culprit lesion morphology was classified as plaque rupture, plaque erosion, or calcified nodule. Thrombus age was subclassified into acute (intraluminal thrombus with surface irregularity) or subacute (mostly mural thrombus with a smooth surface).
Results:
A total of 61 patients who underwent thrombolysis within 24 hours from symptom onset were included, with 38 (59.7%) subjects ≤35 years and 23 (40.3%) subjects >60 years of age. As an underlying mechanism of STEMI thrombosis, plaque erosion was more common in very young patients (52.6% vs 21.7%; p=0.02) while plaque rupture was more common in elderly patients (65.2% vs 36.8%; p=0.03). Acute or subacute thrombus was identified in 68.9% (42/61) of patients, with red thrombus being more frequent in very young patients. In the entire patient cohort, acute thrombus was more frequent in plaque rupture compared with plaque erosion (62.0% vs 28.0%; p=0.01), whereas subacute thrombus was more common in plaque erosion versus plaque rupture (52.0% vs 10.3%; p=0.0008).
Conclusions:
OCT showed that plaque erosion and plaque rupture were the most common underlying STEMI mechanisms in very young patients and older patients, respectively, and that subjects with plaque erosion had greater evidence of subacute thrombus.
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