In vivo vulnerability grading system of plaques causing acute coronary syndromes: An intravascular imaging study

Francesco Prati, Laura Gatto, Enrico Romagnoli, Ugo Limbruno, Massimo Fineschi, Valeria Marco, Mario Albertucci, Corrado Tamburino, Filippo Crea, Fernando Alfonso, Eloisa Arbustini

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Autopsy studies shed light on the interplay between fatal acute coronary syndromes (ACS) and features of plaque vulnerability. This is a prospective pilot study designed for generating a new in vivo imaging grading system of plaque vulnerability. Methods: We studied 87 coronary vessels in 63 consecutive patients: 48 with Acute Coronary Syndrome (ACS) and 15 with stable coronary artery disease using IntraVascular-Ultrasound Near-Infrared-Spectroscopy (IVUS-NIRS) and Optical Coherence Tomography (OCT). We identified 99 lesions: 21 were the ACS culprit lesions (18 ulcerations and 3 with intact fibrous cap), 78 were non-culprit lesions including plaques located in the same ACS culprit vessel (N12), plaques located in a non-culprit vessel in patients with ACS (28) and target lesions of stable patients (N 38). A second analysis focused on lipid plaques, comparing the 18 ACS culprit ulcerated lesions and the 55 non-culprit lesions. Results: The co-presence of the following three features of vulnerability [Minimal Luminal Area (MLA) <4 mm2, Fibrous Cap Thickness (FCT) < 75 μm and superficial macrophages] was by far more frequent in ACS culprit lesions than in controls (OR 40.6 for all lesions and OR 45.7 for ulcerated culprit lesions only). The triple-feature OCT grading identified vulnerable plaques with a much higher accuracy than that obtained applying each single feature of vulnerability. Conclusions: The co-presence of the 3 OCT features of vulnerability (MLA < 4 mm2, FCT < 75 μm and superficial macrophages) identifies culprit ACS lesions with a very high odd ratio. This finding could set the basis for a new OCT vulnerability grading system including superficial macrophages.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Acute Coronary Syndrome
Optical Coherence Tomography
Macrophages
Near-Infrared Spectroscopy
Coronary Artery Disease
Autopsy
Coronary Vessels
Odds Ratio
Prospective Studies
Lipids

Keywords

  • Acute coronary syndrome
  • Intra-vascular ultrasound-near infrared spectroscopy
  • Optical coherence tomography
  • Vulnerable plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

In vivo vulnerability grading system of plaques causing acute coronary syndromes : An intravascular imaging study. / Prati, Francesco; Gatto, Laura; Romagnoli, Enrico; Limbruno, Ugo; Fineschi, Massimo; Marco, Valeria; Albertucci, Mario; Tamburino, Corrado; Crea, Filippo; Alfonso, Fernando; Arbustini, Eloisa.

In: International Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Prati, Francesco ; Gatto, Laura ; Romagnoli, Enrico ; Limbruno, Ugo ; Fineschi, Massimo ; Marco, Valeria ; Albertucci, Mario ; Tamburino, Corrado ; Crea, Filippo ; Alfonso, Fernando ; Arbustini, Eloisa. / In vivo vulnerability grading system of plaques causing acute coronary syndromes : An intravascular imaging study. In: International Journal of Cardiology. 2018.
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T2 - An intravascular imaging study

AU - Prati, Francesco

AU - Gatto, Laura

AU - Romagnoli, Enrico

AU - Limbruno, Ugo

AU - Fineschi, Massimo

AU - Marco, Valeria

AU - Albertucci, Mario

AU - Tamburino, Corrado

AU - Crea, Filippo

AU - Alfonso, Fernando

AU - Arbustini, Eloisa

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N2 - Background: Autopsy studies shed light on the interplay between fatal acute coronary syndromes (ACS) and features of plaque vulnerability. This is a prospective pilot study designed for generating a new in vivo imaging grading system of plaque vulnerability. Methods: We studied 87 coronary vessels in 63 consecutive patients: 48 with Acute Coronary Syndrome (ACS) and 15 with stable coronary artery disease using IntraVascular-Ultrasound Near-Infrared-Spectroscopy (IVUS-NIRS) and Optical Coherence Tomography (OCT). We identified 99 lesions: 21 were the ACS culprit lesions (18 ulcerations and 3 with intact fibrous cap), 78 were non-culprit lesions including plaques located in the same ACS culprit vessel (N12), plaques located in a non-culprit vessel in patients with ACS (28) and target lesions of stable patients (N 38). A second analysis focused on lipid plaques, comparing the 18 ACS culprit ulcerated lesions and the 55 non-culprit lesions. Results: The co-presence of the following three features of vulnerability [Minimal Luminal Area (MLA) <4 mm2, Fibrous Cap Thickness (FCT) < 75 μm and superficial macrophages] was by far more frequent in ACS culprit lesions than in controls (OR 40.6 for all lesions and OR 45.7 for ulcerated culprit lesions only). The triple-feature OCT grading identified vulnerable plaques with a much higher accuracy than that obtained applying each single feature of vulnerability. Conclusions: The co-presence of the 3 OCT features of vulnerability (MLA < 4 mm2, FCT < 75 μm and superficial macrophages) identifies culprit ACS lesions with a very high odd ratio. This finding could set the basis for a new OCT vulnerability grading system including superficial macrophages.

AB - Background: Autopsy studies shed light on the interplay between fatal acute coronary syndromes (ACS) and features of plaque vulnerability. This is a prospective pilot study designed for generating a new in vivo imaging grading system of plaque vulnerability. Methods: We studied 87 coronary vessels in 63 consecutive patients: 48 with Acute Coronary Syndrome (ACS) and 15 with stable coronary artery disease using IntraVascular-Ultrasound Near-Infrared-Spectroscopy (IVUS-NIRS) and Optical Coherence Tomography (OCT). We identified 99 lesions: 21 were the ACS culprit lesions (18 ulcerations and 3 with intact fibrous cap), 78 were non-culprit lesions including plaques located in the same ACS culprit vessel (N12), plaques located in a non-culprit vessel in patients with ACS (28) and target lesions of stable patients (N 38). A second analysis focused on lipid plaques, comparing the 18 ACS culprit ulcerated lesions and the 55 non-culprit lesions. Results: The co-presence of the following three features of vulnerability [Minimal Luminal Area (MLA) <4 mm2, Fibrous Cap Thickness (FCT) < 75 μm and superficial macrophages] was by far more frequent in ACS culprit lesions than in controls (OR 40.6 for all lesions and OR 45.7 for ulcerated culprit lesions only). The triple-feature OCT grading identified vulnerable plaques with a much higher accuracy than that obtained applying each single feature of vulnerability. Conclusions: The co-presence of the 3 OCT features of vulnerability (MLA < 4 mm2, FCT < 75 μm and superficial macrophages) identifies culprit ACS lesions with a very high odd ratio. This finding could set the basis for a new OCT vulnerability grading system including superficial macrophages.

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KW - Intra-vascular ultrasound-near infrared spectroscopy

KW - Optical coherence tomography

KW - Vulnerable plaque

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