Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study

Ziqian Weng; Chen Zhao; Yuhan Qin; Cong Liu; Weili Pan; Sining Hu; Luping He; Yishuo Xu; Ming Zeng; Xue Feng; Rui Gao; Xianghao Yu; Minghao Liu; Boling Yi; Dirui Zhang; Ekaterina Koniaeva; Timur Musin; Diler Mohammad; Bin Zhu; Yanli Sun; Jingbo Hou; Jiawei Tian; Gary S Mintz; Haibo Jia; Bo Yu

doi:10.1016/j.ahj.2023.06.006

Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study

Am Heart J. 2023 Sep:263:159-168. doi: 10.1016/j.ahj.2023.06.006. Epub 2023 Jun 14.

Authors

Ziqian Weng¹, Chen Zhao¹, Yuhan Qin¹, Cong Liu², Weili Pan¹, Sining Hu¹, Luping He¹, Yishuo Xu¹, Ming Zeng¹, Xue Feng¹, Rui Gao¹, Xianghao Yu¹, Minghao Liu¹, Boling Yi¹, Dirui Zhang¹, Ekaterina Koniaeva¹, Timur Musin¹, Diler Mohammad¹, Bin Zhu¹, Yanli Sun¹, Jingbo Hou¹, Jiawei Tian², Gary S Mintz³, Haibo Jia¹, Bo Yu⁴

Affiliations

¹ Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
² Department of Ultrasound, The second Affiliated Hospital of Harbin Medical University, Harbin, China.
³ Cardiovascular Research Foundation, New York, 10019 NY, USA.
⁴ Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.

PMID: 37327980
DOI: 10.1016/j.ahj.2023.06.006

Abstract

Background: Plaque rupture (PR) and plaque erosion (PE) are 2 distinct, different, and most common culprit lesion morphologies responsible for acute coronary syndrome (ACS). However, the prevalence, distribution, and characteristics of peripheral atherosclerosis in ACS patients with PR vs PE has never been studied. The aim of this study was to assess peripheral atherosclerosis burden and vulnerability evaluated by vascular ultrasound in ACS patients with coronary PR vs PE identified by optical coherence tomography (OCT).

Methods: Between October 2018 and December 2019, 297 ACS patients who underwent preintervention OCT examination of the culprit coronary artery were enrolled. Peripheral ultrasound examinations of carotid, femoral, and popliteal arteries were performed before discharge.

Results: Overall, 265 of 297 (89.2%) patients had at least one atherosclerotic plaque in a peripheral arterial bed. Compared with coronary PE, patients with coronary PR had a higher prevalence of peripheral atherosclerotic plaques (93.4% vs 79.1%, P < .001), regardless of location: carotid, femoral, or popliteal arteries. The number of peripheral plaques per patient was significantly larger in the coronary PR group than coronary PE (4 [2-7] vs 2 [1-5], P < .001). Additionally, there was a greater prevalence of peripheral vulnerable characteristics including plaque surface irregularity, heterogeneous plaque, and calcification in patients with coronary PR vs PE.

Conclusions: Peripheral atherosclerosis exists commonly in patients presenting with ACS. Patients with coronary PR had greater peripheral atherosclerosis burden and more peripheral vulnerability compared to those with coronary PE, suggesting that comprehensive evaluation of peripheral atherosclerosis and multidisciplinary cooperative management maybe necessary, especially in patients with PR.

Trial registration: clinicaltrials.gov (NCT03971864).

Associated data

ClinicalTrials.gov/NCT03971864