Clinical features and lipid profiles of plaque erosion over lipid-rich plaque versus fibrous plaque in patients with acute coronary syndrome

Abstract

Background and aims: Pathological reports have shown that plaque erosion (PE), a common cause of acute coronary syndrome (ACS), can form in both fibrous plaque and lipid-rich plaque (LRP). In plaque rupture (PR), which is the main cause of ACS, the underlying plaque is LRP with a thin fibrous cap. In this study, we aimed to investigate the clinical features and lipid profiles of PE with or without LRP in comparison with those of PR.

Methods: A total of 166 patients with ACS, who underwent percutaneous coronary intervention using optical coherence tomography (OCT) and met the criteria for PR or PE, were included. LRP was defined as plaque with a maximal lipid arc (>180°). Culprit lesions were categorized into PR and PE with/without LRP [PE_(Lipid) or PE_(Fibrous)].

Results: The prevalence of PR, PE_(Lipid), and PE_(Fibrous) was 104 (62.7%), 43 (25.9%), and 19(11.4%), respectively. The patients with PR and PE_(Lipid) had a significantly higher peak creatine kinase level (1338 and 1584U/L, respectively, p < 0.01) and prevalence of ST-elevation myocardial infarction (71.2% and 79.1%, respectively, p < 0.01) than those with PE_(Fibrous) (214U/L and 21.1%, respectively). The various lipid profiles were mostly comparable between the patients with PE_(Lipid) and PR, but different in those with PE_(Fibrous). The levels of small dense low-density lipoprotein cholesterol were significantly higher in the patients with PR and PE_(Lipid) than in those with PE_(Fibrous) (39.0, 35.3, and 25.7 mg/dL, respectively, p = 0.02).

Conclusions: The clinical features and lipid profiles are substantially different between PE_(Lipid) and PE_(Fibrous), but are somewhat similar between PE_(Lipid) and PR.

Keywords: Acute coronary syndrome; Lipid-rich plaque; Optical coherence tomography; Plaque erosion.