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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence
Marco Covani1, Giampaolo Niccoli2, Daichi Fujimoto3
1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Department, University Hospital of Parma, Parma, Italy.
Insights
More cardiovascular risk factors in acute coronary syndrome (ACS) patients correlate with increased plaque vulnerability. This highlights how traditional risk factors contribute to adverse clinical outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pathology
Background:
- Cardiovascular risk factors are linked to poor outcomes in acute coronary syndrome (ACS).
- While individual risk factors are associated with specific plaque types, the impact of cumulative risk factors on plaque vulnerability is unclear.
Purpose of the Study:
- To investigate the association between the number of cardiovascular risk factors and plaque vulnerability.
- Plaque vulnerability was assessed using optical coherence tomography (OCT).
Main Methods:
- Patients with ACS were grouped by the number of traditional risk factors (diabetes, hypertension, hyperlipidemia, smoking).
- Vulnerable plaque features were analyzed in both culprit and non-culprit lesions using OCT.
- Groups included 0-1 risk factors versus 2 or more risk factors.
Main Results:
- In culprit lesions, increased risk factors correlated with higher prevalence of lipid-rich plaques, thin-cap fibroatheromas, macrophages, microvessels, and cholesterol crystals.
- Having 2 or more risk factors was linked to all vulnerable features except lipid-rich plaques.
- Plaque rupture increased with more risk factors, while plaque erosion decreased.
- Non-culprit lesions showed associations between risk factors and macrophages, cholesterol crystals, and cumulative vulnerable features.
Conclusions:
- An increasing number of cardiovascular risk factors is strongly associated with greater plaque vulnerability in ACS patients, particularly in culprit lesions.
- These findings help explain the link between traditional risk factors and adverse clinical events.
Background:
Cardiovascular risk factors are strongly associated with adverse clinical outcomes, including acute coronary syndrome (ACS). Although individual risk factors have been related to specific plaque phenotypes, the relationship between the cumulative number of risk factors and plaque vulnerability has not been systematically explored.
Objectives:
The purpose of this study was to investigate the association between the number of cardiovascular risk factors and plaque vulnerability defined by optical coherence tomography.
Methods:
Patients with ACS were divided into 5 groups based on their number of traditional risk factors (diabetes, hypertension, hyperlipidemia, smoking) or into 2 groups (0-1 vs ≥2 risk factors). Features of vulnerability in both culprit and nonculprit lesions were analyzed.
Results:
Of 2,187 plaques analyzed, 1,581 were culprit and 606 nonculprit plaques. In culprit plaques, the prevalence of lipid-rich plaques (P trend = 0.027), thin-cap fibroatheromas (P trend = 0.006), macrophages (P trend <0.001), microvessels (P trend <0.001), and cholesterol crystals (P trend = 0.032) increased as the number of risk factors increased. The presence of ≥2 risk factors was independently associated with all vulnerable features except lipid-rich plaques. Plaque rupture showed an increasing prevalence as the number of risk factors increased (P trend = 0.015), whereas plaque erosion showed a decreasing trend (P trend <0.001). In nonculprit plaques, only macrophages, cholesterol crystals, and the cumulative number of vulnerable features in each plaque exhibited a significant positive association with the number of risk factors.
Conclusions:
In patients with ACS, an increasing number of cardiovascular risk factors were strongly associated with greater plaque vulnerability, especially for culprit lesions. These findings may explain the relationship between traditional risk factors and adverse clinical outcomes.
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