RESUMO
BACKGROUND: Healed plaques are frequently found in patients with acute coronary syndrome, but the prognostic value is debatable. This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography (OCT) with the aim of predicting plaque progression of healed plaques. METHODS: This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT imaging and follow-up angiography from January 2015 to December 2019. Plaque progression predictors were assessed by multivariate analysis. RESULTS: Among 113 non-culprit lesions, 27 healed plaques (23.9%) were identified. Patients with non-culprit healed plaques had prior antiplatelet therapy (65.0% vs. 33.8%, P = 0.019), hypertension (85.0% vs. 50.7%, P = 0.009), and dyslipidemia (70.0% vs. 41.5%, P = 0.04) which were more frequently than those without healed plaques. The thickness (r = 0.674, P < 0.001), arc ( r = 0.736, P < 0.001), and volume ( r = 0.541, P = 0.004) of healed plaque were correlated with minimum lumen diameter changes. At a mean follow-up of 11.5 months, the non-culprit healed plaques had a lower minimum lumen diameter (1.61 ± 0.46 mm vs. 1.91 ± 0.73 mm, P = 0.016), lower average lumen diameter (1.86 mm vs. 2.10 mm, P = 0.033), and a higher degree of diameter stenosis (41.4% ± 11.9% vs. 35.5% ± 13.1%, P = 0.031) when compared to baseline measurements. The plaque progression rate was higher in the healed plaque group (33.3% vs. 8.1%, P = 0.002), and multivariate analysis identified healed plaques [odds ratio (OR) = 8.49, 95% CI: 1.71-42.13] and lumen thrombus (OR = 10.69, 95% CI: 2.21-51.71) as predictors of subsequent lesion progression. CONCLUSIONS: Healed plaques were a predictor for rapid plaque progression. The quantitative parameters of healed plaque showed a good agreement with plaque progression. Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol. Bifurcation lesions might be the predilection sites of healed plaques.
RESUMO
BACKGROUND: Subclinical hypothyroidism (SCH) has recently been acknowledged as an unconventional risk factor for coronary artery disease (CAD) and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. METHODS: Patients with coronary artery disease were enrolled in the study and divided into an SCH group (patients, n = 26; plaques, n = 35) and a non-SCH group (patients, n = 52; plaques, n = 66). They were divided 1: 2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography (OCT) imaging was performed on all patients, and images were analyzed by two independent investigators. Lipid-rich plaques (LRP), the precursor of vulnerable plaques, were defined as having more than one quadrant occupied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The presence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. RESULTS: The ratio of LRP in SCH group was significantly higher than that in non-SCH group (54% vs. 30.3%, P = 0.037). That was the case as well for the maximum lipid arcs value (181.5° ± 61.6° vs. 142.1° ± 35.9°, P = 0.046). While thin-cap fibroatheroma (TCFA) was detected, no difference was identified between the two groups in either TCFA ratio (20% vs. 16.7%, P = 0.579) or fibrous cap thickness (57.5 ± 14.0 vs. 63.5 ± 10.7 µm, P = 0.319). Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. CONCLUSION: Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
