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Predictors for layered coronary plaques: an optical coherence tomography study

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Abstract

Healed coronary plaques, morphologically characterized by a layered pattern, are signatures of previous plaque disruption and healing. Recent optical coherence tomography (OCT) studies showed that layered plaque is associated with vascular vulnerability. However, factors associated with layered plaques have not been studied. The aim of this study was to investigate predictors for layered plaque at the culprit plaques and at non-culprit plaques. Patients with coronary artery disease who underwent pre-intervention OCT imaging of the culprit lesion were included. Layered plaques were defined as plaques with one or more layers of different optical density and a clear demarcation from underlying components. Among 313 patients, layered plaque at the culprit lesion was observed in 18.8% of ST-segment elevation myocardial infarction patients, 36.3% of non-ST-segment elevation acute coronary syndrome patients, and 53.4% of stable angina pectoris (SAP) patients (p < 0.001). In the multivariable model, SAP, multivessel disease, type B2/C lesion, and diameter stenosis > 70% were independent predictors for layered plaque at the culprit lesion. In addition, 394 non-culprit plaques in 190 patients were assessed to explore predictors for layered plaques at non-culprit lesions. SAP, and thin-cap fibroatheroma and layered plaque at the culprit lesion were independent predictors for layered plaques at non-culprit lesions. In conclusion, clinical presentation of SAP was a strong predictor for layered plaque at both culprit plaques and non-culprit plaques. Development and biologic significance of layered plaques may be related to a balance between pan-vascular vulnerability and endogenous anti-thrombotic protective mechanism.

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Acknowledgements

Ik-Kyung Jang’s research was supported by Mr. Michael and Mrs. Kathryn Park and by Mrs. Gill and Mr. Allan Gray. We are grateful to Iris McNulty, RN (Massachusetts General Hospital) for coordination and editorial work.

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Authors and Affiliations

  1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA

    Makoto Araki, Michele Russo, Osamu Kurihara, Hyung Oh Kim, Hiroki Shinohara, Vikas Thondapu & Ik-Kyung Jang

  2. Department of Interventional Cardiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan

    Makoto Araki & Taishi Yonetsu

  3. Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan

    Tsunenari Soeda

  4. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Yoshiyasu Minami

  5. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Takumi Higuma

  6. Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Hang Lee

  7. Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan

    Tsunekazu Kakuta

  8. Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea

    Ik-Kyung Jang

Authors
  1. Makoto Araki
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  2. Taishi Yonetsu
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  3. Michele Russo
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  4. Osamu Kurihara
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  5. Hyung Oh Kim
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  6. Hiroki Shinohara
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  7. Vikas Thondapu
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  8. Tsunenari Soeda
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  9. Yoshiyasu Minami
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  10. Takumi Higuma
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  11. Hang Lee
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  12. Tsunekazu Kakuta
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  13. Ik-Kyung Jang
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Corresponding authors

Correspondence to Taishi Yonetsu or Ik-Kyung Jang.

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Conflict of interest

Ik-Kyung Jang has received educational grants from Abbott Vascular. They had no role in the design or conduct of this research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Araki, M., Yonetsu, T., Russo, M. et al. Predictors for layered coronary plaques: an optical coherence tomography study. J Thromb Thrombolysis 50, 886–894 (2020). https://doi.org/10.1007/s11239-020-02116-5

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  • DOI: https://doi.org/10.1007/s11239-020-02116-5

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