Clinical determinants of coronary artery disease burden and vulnerability using optical coherence tomography co-registered with intravascular ultrasound. Issue 2 (17th August 2021)

• Record Type: Journal Article
• Authors: Zhang, Wenbin; Mintz, Gary S.; Cao, Yang; Matsumura, Mitsuaki; Lee, Tetsumin; Hoshino, Masahiro; Usui, Eisuke; Kanaji, Yoshihisa; Murai, Tadashi; Yonetsu, Taishi; Kakuta, Tsunekazu; Maehara, Akiko
• Is Part Of: Coronary artery disease. Volume 33:Issue 2(2022)
• Page Start: 114
• Page End: 124
• Publication Date: 2021-08-17
• Subjects: acute coronary syndromes -- coronary artery disease -- plaque morphology -- risk factors; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000001088
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Objectives: We investigated clinical determinants of disease burden and vulnerability using optical coherence tomography (OCT) co-registered with intravascular ultrasound (IVUS) in a large cohort of patients. Methods: A total of 704 patients [44.5% with acute coronary syndromes (ACS)] underwent coronary intervention. IVUS plaque burden and OCT lipid, macrophage and calcium indices and the presence of thrombus, plaque rupture and thin-cap fibroatheroma (TCFA) were analyzed. Results: Median patient age was 66 years with 81.8% men, 34.4% with diabetes mellitus and 15.5% with preadmission statins. Median lesion length was 25.7 mm, and 33.0% had a TCFA. Adjusted models indicated (1) older patient age was related to more calcium, but fewer macrophages; (2) men were related to more thrombus with plaque rupture while women had more thrombus without plaque rupture; (3) ACS presentation was related to morphological acute thrombotic events (more thrombus with/without rupture) and plaque vulnerability (more TCFA, more lipid and macrophages and larger plaque burden); (4) diabetes mellitus was related to a greater atherosclerotic disease burden (more lipid and calcium and larger plaque burden) and more thrombus without rupture; (5) hypertension was related to more macrophages; (6) current smoking was related to less calcium; and (7) renal insufficiency and preadmission statin therapy were not independently associated with IVUS or OCT plaque morphology. Conclusion: Patient characteristics, especially diabetes mellitus and aging, affect underlying atherosclerotic burden, among which a greater lipidic burden along with sex differences influence local thrombotic morphology that affects clinical presentation.