Radial Wall Strain Derived From Coronary Angiography Reflects Plaque Morphology of Future Acute Coronary Syndrome

Radial wall strain (RWS) is a potential marker of plaque vulnerability; however, its association with plaque morphology in future acute coronary syndrome (ACS) remains unclear.

We retrospectively enrolled 98 patients with ACS who underwent optical coherence tomography-guided percutaneous coronary intervention and had a prior coronary angiography (CAG) 1 month to 5 years before ACS. RWS was calculated as the maximum percentage change in lumen diameter within a cardiac cycle (RWS_max). Mild-to-intermediate stenotic lesions on the index CAG were classified as culprit lesions (CLs) and non-CLs (NCLs) of ACS. CLs were further categorized as plaque rupture (PR) or erosion (PE). We identified 74 CLs (50 PRs, 24 PEs) and 96 NCLs. Angiographic and physiological parameters were comparable across the groups; however, RWS_maxwas significantly higher in both PRs and PEs than in NCLs (15.8% vs. 12.6%, P<0.001; 14.1% vs. 12.6%, P=0.012, respectively). In Cox regression analysis, RWS_maxwas associated with subsequent PRs (hazard ratio [HR] 1.56; 95% confidence interval [CI] 1.34-1.82; P<0.001) and PEs (HR 1.33; 95% CI 1.05-1.67; P=0.017). Multinomial logistic regression showed that higher RWS_maxfavored PR, lower RWS_maxfavored NCL, and the estimated probability of PE remained low across the RWS_maxspectrum.

RWS_maxwas independently associated with subsequent PR and PE, with a higher estimated probability of PR than of PE.