Difference in plaque characteristics of coronary culprit lesions in a cohort of Egyptian patients presented with acute coronary syndrome and stable coronary artery disease: An optical coherence tomography study

Amr ElFaramawy; Mina Youssef; Mohamed Abdel Ghany; Khaled Shokry

doi:10.1016/j.ehj.2017.12.002

Difference in plaque characteristics of coronary culprit lesions in a cohort of Egyptian patients presented with acute coronary syndrome and stable coronary artery disease: An optical coherence tomography study

Egypt Heart J. 2018 Jun;70(2):95-100. doi: 10.1016/j.ehj.2017.12.002. Epub 2017 Dec 27.

Authors

Amr ElFaramawy^{1

2}, Mina Youssef¹, Mohamed Abdel Ghany¹, Khaled Shokry³

Affiliations

¹ Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Cardiology Department, Aswan Heart Center, Aswan, Egypt.
³ Department of Cardiology, Kobry El Kobba Military Hospital, Cairo, Egypt.

Abstract

Aims: This study was designed to utilize frequency-domain optical coherence tomography (FD-OCT) for assessment of plaque characteristics and vulnerability in patients with acute coronary syndrome (ACS) compared to stable coronary artery disease (SCAD).

Methods and results: We enrolled 48 patients; divided into an ACS-group (27 patients) and SCAD-group (21 patients) according to their clinical presentation. Hypertension and diabetes mellitus were more prevalent in SCAD group. Patients with ACS showed higher frequency of lipid-rich plaques (96.3% vs. 66.7%, P = .015), lower frequency of calcium plaques (7.4% vs. 57.1%, P < .001), and fibrous plaques (14.8% vs. 81%, P < .001) when compared with SCAD patients. The TCFA (defined as lipid-rich plaque with cap thickness <65 μm) identified more frequently (33.3% vs. 14.3%, P = .185), with a trend towards thinner median fibrous cap thickness (70 (50-180) µm vs. 100 (50-220) µm, P = .064) in ACS group. Rupture plaque (52% vs. 14.3%, P = .014), plaque erosion (18.5% vs. 0%, P = .059) and intracoronary thrombus (92.6% vs. 14.3%, P < .001) were observed more frequently in ACS group, while cholesterol crystals were identified frequently in patients with SCAD (0.0% vs. 33.3%, P = .002).

Conclusion: The current FD-OCT study demonstrated the differences of plaque morphology and identified distinct lesion characteristics between patients with ACS and those with SCAD. These findings could explain the clinical presentation of patients in both groups.

Keywords: %AS, percent area stenosis; ACS, acute coronary syndrome; Clinical presentation; ECG, electrocardiogram; EF, ejection fraction; FCT, fibrous cap thickness; FD-OCT, frequency-domain optical coherence tomography; Frequency-domain optical coherence tomography; ICC, intra-class correlation; IVUS, intravascular ultrasound virtual histologic; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; MFCT, minimum fibrous cap thickness; MLCSA, minimum luminal cross sectional area; NSTE-ACS, non-ST-elevation acute coronary syndrome; Plaque characteristics; RCA, right coronary artery; SAP, stable angina pectoris; SCAD, stable coronary artery disease; STEMI, ST elevation myocardial infarction; TCFAs, thin cap fibroatheromas.