Feature Of The Week 8/4/13: MGH OCT Registry Reports on In Vivo OCT Studies of Plaque Erosion and Calcified Nodule In Acute Coronary Syndrome
Pathology studies reported that three most common causes of acute coronary syndrome (ACS) or sudden cardiac death are plaque rupture, plaque erosion and calcified nodules. The morphological and clinical characteristics of the underlying pathology of ACS, especially plaque erosion and calcified nodule, have never been well studied in vivo. Using optical coherence tomography, we found that plaque erosions are the substrate for ACS in 31% of patients and calcified nodules in 8% of patients, which are consistent with pathological findings. Erosions are more likely to cause non-ST-segment elevation ACS than ST-segment elevation myocardial infarction. Compared to plaque rupture, plaque erosion had a thicker fibrous cap, smaller lipid arc, and less severe luminal narrowing. This study represents the largest systematic in vivo analysis of plaque erosions and calcified nodules to date. The distinct pathologic features and clinical characteristics associated with PR, OCT-erosion, and OCT-CN suggest that they may be caused by different pathophysiologic processes, and therefore patients with OCT-erosion may be stabilized by effective antithrombotic treatment without stent implantation, thereby avoiding both early and late complications associated with stent. However, prospective, randomized study is needed to support our findings to guide clinical practice.
For more information see link to MGH OCT Registry Here and recent Article. Courtesy of Haibo Jia from Massachusetts General Hospital.