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Bivalirudin vs. Heparin on Radial Artery Thrombosis during Transradial Coronary Intervention: An Optical Coherence Tomography Study. J Interv Cardiol 2020; 2020:7905021. [PMID: 33071677 PMCID: PMC7533783 DOI: 10.1155/2020/7905021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aimed to evaluate the antithrombotic efficacy between bivalirudin and unfractionated heparin (UFH) on radial artery thrombosis (RAT) during transradial coronary intervention (TRI) by optical coherence tomography (OCT). Methods and Results We consecutively reviewed a total of 307 patients who underwent radial artery OCT inspection after TRI in our centre from October 2017 to January 2019; afterwards, 211 screened patients were divided into the UFH group (n = 144) and the bivalirudin group (n = 67) according to their anticoagulation strategy during TRI. The thrombosis in the radial artery was observed in 51 cases (24.17%) with a median thrombus volume of 0.054 mm3 (0.024, 0.334) and median thrombus score of 7 (4, 15). Thrombus occurred in 28 cases in the bivalirudin group with an incidence of 41.8%, which was significantly higher than that in the UFH group (n = 23, 16.0%, P < 0.001). This difference was even more remarkable after propensity score matching (bivalirudin group n = 22, 42.3% vs. UHF group n = 11, 13.9%, P < 0.001). Multivariate logistic analysis revealed that bivalirudin increased the RAT risk by 3.872 times (95% CI 2.006–8.354, P < 0.001) after adjustment for the other predictors. Conclusion In this present study, the use of bivalirudin was associated with a higher risk of RAT than UFH. It highlighted UFH should be a more considerable choice to prevent radial artery access thrombosis in TRI.
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Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome. J Thromb Thrombolysis 2020; 51:1026-1035. [PMID: 32955695 DOI: 10.1007/s11239-020-02281-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P < 0.001), and the incidence of STEMI caused by PE was significantly lower on antiplatelet therapy (P < 0.001) or on statin therapy (P < 0.001). Antiplatelet therapy is associated with lower probability of STEMI, regardless of underlying pathology, and statin therapy is associated with lower probability of STEMI in PE as clinical presentation of ACS. Statin therapy prior to the onset of acute coronary syndromes (ACS) may reduce the probability of plaque rupture. Antiplatelet therapy prior to the onset of ACS is associated with reduced probability of ST-segment elevation myocardial infarction (STEMI) following both plaque rupture and plaque erosion, and dual antiplatelet therapy offers additional protection compared to a single antiplatelet agent in plaque erosion. The combination of statin and antiplatelet therapy may have an additive effect on reducing the probability of STEMI caused by plaque erosion. Yellow: lipid pool(necrotic core); red: fibrin-rich thrombus; gray; platelet-rich thrombus.
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Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography. J Interv Cardiol 2020; 2020:8263923. [PMID: 32774188 PMCID: PMC7395998 DOI: 10.1155/2020/8263923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.
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Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study. J Thromb Thrombolysis 2020; 51:379-387. [PMID: 32651890 DOI: 10.1007/s11239-020-02220-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00-05:59, 06:00-11:59, 12:00-17:59, or 18:00-23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups. Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 09:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture significantly increased in the periods of 06:00-11:59 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.30-3.49, p = 0.002] and 12:00-17:59 (OR 2.10, 95% CI 1.23-3.58, p = 0.005), compared to the period of 00:00-05:59. This circadian pattern was observed only during weekdays (p = 0.010) and it was not evident during the weekend (p = 0.742). Plaque rupture occurred most frequently in the morning and this circadian variation was evident only during weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.
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55
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Liu J, Wang S, Cui C, Cai H, Sun R, Pan W, Fang S, Yu B. The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction. Cardiovasc Diabetol 2020; 19:109. [PMID: 32641042 PMCID: PMC7341636 DOI: 10.1186/s12933-020-01074-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background Plaque rupture (PR) and plaque erosion (PE) are main causes of acute myocardial infarction with different demographic and histology characteristics and need different treatment strategy. PR and PE can be identified with optical coherence tomography (OCT) accurately, but convenient and effective noninvasive markers for them are rarely found. History of diabetes mellitus (DM) was reported to be a potential predictor of PR in ST-segment elevated myocardial infarction (STEMI) patients, but the predictive value of other glucose-related variables for it is still uncertain. Present study aimed to clear the relationship between some glucose-related variables and plaque morphology in patients with STEMI. Methods We consecutively enrolled 872 STEMI patients and divided them into PR group (n = 616) and PE group (n = 256) based on OCT diagnostic criteria. The relationship of glucose-related variables, including random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose (PFPG), DM history, glucose variable tendency (GVT) and the acute-to-chronic glycemic ratio (A/C), to the PR risk of STEMI patients was analyzed. The correlation between the glucose-related variables and plaque morphology was analyzed meanwhile. Results Among the glucose-related variables, ARPG and GVT were confirmed to be independent predictors for PR after adjusting for other traditional risk factors in nondiabetic patients. The higher the ARPG level, the more PR risk the STEMI patients had. And high HbA1c and APPG were demonstrated to have a weak and positive correlation with lipid constituents and stenosis degree of culprit vessel. Conclusions Compared to HbA1c, DM history, and some other glucose-related variables, ARPG and GVT were risk factors for PR in STEMI patients, especially those without DM. And high HbA1c and ARPG were positively correlated with the development of vulnerable plaque in culprit vessels. Trial registration Present study is a retrospective one and the population came from the EROSION study of our center previously. It was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (Approval reference number, KY2017-249), and all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.
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Affiliation(s)
- Jinxin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Shanjie Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Can Cui
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Hengxuan Cai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Rong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Weili Pan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Shaohong Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China. .,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, 150086, Heilongjiang, China.
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56
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Kurihara O, Takano M, Soeda T, Fracassi F, Araki M, Nakajima A, McNulty I, Lee H, Mizuno K, Jang IK. Degree of luminal narrowing and composition of thrombus in plaque erosion. J Thromb Thrombolysis 2020; 51:143-150. [PMID: 32472306 DOI: 10.1007/s11239-020-02159-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As the degree of luminal narrowing increases, shear stress increases, and high shear stress is known to activate platelets. However, the relationship between the degree of luminal narrowing and the composition of thrombus in patients with plaque erosion has not been studied. A total of 148 patients with plaque erosion and thrombus detected by optical coherence tomography were divided into tertiles based on the minimum lumen area (MLA) at the culprit lesion. Thrombus was categorized as platelet-rich or fibrin-rich. Among 148 patients, 50 (34%) were in the mild stenosis group, 49 (33%) were in the moderate stenosis group, and 49 (33%) were in the severe stenosis group. The composition of thrombus was significantly different among the 3 groups (prevalence of platelet-rich thrombus was 60% in the mild stenosis group; 78% in the moderate stenosis group; and 84% in the severe stenosis group; P = 0.021). The pattern of fibrin-rich thrombus showed the opposite: 40%, 22%, and 16%, respectively. In the multivariate analysis, current smoking was independently associated with fibrin-rich thrombus (odds ratio [OR] 2.364 [95% CI 1.004-5.567], P = 0.049). This study demonstrated that platelet-rich thrombus was the predominant type of thrombus in plaque erosion. The prevalence of fibrin-rich thrombus was highest in the mild stenosis group.
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Affiliation(s)
- Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba, 270-1694, Japan.
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Francesco Fracassi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA. .,Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea.
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57
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Hou F, Zhou Y, Liu W, Yang S, Wang Z, Ma X, Du Y, Li Y, Guan J. Characteristics of culprit lesions in young patients with metabolic syndrome and classic cardiovascular risk factors. Exp Ther Med 2020; 19:2766-2772. [PMID: 32256759 DOI: 10.3892/etm.2020.8484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/06/2020] [Indexed: 01/23/2023] Open
Abstract
The association between cardiovascular risk factors (CVRFs) and characteristics of coronary plaque in young patients has remained to be fully elucidated. Therefore, the present study sought to determine the association between CVRFs and phenotypes of culprit coronary plaques revealed by optical coherence tomography (OCT) in young patients with stable coronary heart disease (CHD) and acute coronary syndrome (ACS). OCT imaging pullback was performed at corresponding sites on 123 lesions in 123 young patients (age, 36±7 years), including those with stable CHD and ACS. Patients with analyzable OCT images were classified as having thin-cap fibroatheromas (TCFAs), plaque rupture, macrophage accumulation, calcified nodule, vasa vasorum, cholesterol crystal and erosion. TCFAs were more prevalent in patients with metabolic syndrome (MetS) than in those without MetS (P=0.020). Plaque rupture was more common in smokers than in non-smokers (P=0.002). Multivariate analysis indicated that MetS was independently associated with TCFAs (P=0.041) and smoking was independently associated with plaque rupture (P=0.006). Young patients with MetS were demonstrated to have more extensive TCFAs and young smokers had a higher prevalence of culprit plaque rupture.
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Affiliation(s)
- Fangjie Hou
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Ya Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China.,Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Jun Guan
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
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58
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Meier D, Skalidis I, De Bruyne B, Qanadli SD, Rotzinger D, Eeckhout E, Collet C, Muller O, Fournier S. Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale. IJC HEART & VASCULATURE 2020; 27:100496. [PMID: 32181323 PMCID: PMC7063126 DOI: 10.1016/j.ijcha.2020.100496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 11/02/2022]
Abstract
Background In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS). Aims The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS. Methodology We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared. Potential significance In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.
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Key Words
- ACS, Acute coronary syndrome
- AE, Adverse Event
- Acute coronary syndrome
- CMRI, Cardiac Magnetic resonance imaging
- CT, Computed tomography
- Coronary computed tomography
- ECG, Electrocardiogram
- ED, Emergency department
- FFR, Fractional Flow Reserve
- FFR-CT
- FFR-CT, FFR derived from coronary CT
- Fractional Flow Reserve
- Hs-Tn, High-sensitive troponins
- MACE, Major adverse cardiac events
- MI, Myocardial infraction
- NSTE-ACS, Acute coronary syndromes without ST-segment elevation
- NSTEMI, Non-ST-elevation myocardial infarction
- PCI, Percutaneous Coronary Intervention
- STEMI, ST-elevation myocardial infarction
- URL, Upper Range Limit
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center Aalst, Aalst, Belgium
| | - Salah Dine Qanadli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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Du BB, Tong YL, Wang XT, Liu GH, Liu K, Yang P, He YQ. Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift under 3D optical coherence tomography: A case report. World J Clin Cases 2020; 8:848-853. [PMID: 32149070 PMCID: PMC7052562 DOI: 10.12998/wjcc.v8.i4.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists. Left main (LM) bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult. Ostial compromise of the side branch decreases patient prognosis, and its management is still an issue despite the different strategies and devices available.
CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope. Coronary angiography showed acute LM occlusion. Following thrombus aspiration, a LM bifurcation lesion remained. Coronary angiography was repeated one week later, and at the same time, 3D optical coherence tomography (OCT) was carried out to better show the geometry of the bifurcation, which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina. After assessment of the plaque characteristics and the minimum lumen area, the cross-over strategy, kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion. A “moving” carina was found twice during the intervention. Good stent apposition and expansion were confirmed by OCT after proximal optimization technique. The three-month follow-up showed good recovery and normal cardiac function.
CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.
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Affiliation(s)
- Bei-Bei Du
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ya-Liang Tong
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Xing-Tong Wang
- Department of Hematology and Oncology, Cancer Center, The First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Guo-Hui Liu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Kun Liu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Yu-Quan He
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
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60
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Yamaguchi M, Sugiyama T, Hoshino M, Kanaji Y, Hada M, Usui E, Yonetsu T, Kakuta T. Two distinct phenotypes of plaque erosion assessed by multimodality intracoronary imaging: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32128487 PMCID: PMC7047054 DOI: 10.1093/ehjcr/ytz241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/17/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022]
Abstract
Background Pathological studies have reported that patients with acute coronary syndrome (ACS) may have different plaque morphologies at culprit lesions, and one of the underlying mechanisms for ACS is plaque erosion. However, the morphological features of plaque erosion obtained by multiple intracoronary imaging modalities have not been fully elucidated. Case summary We experienced two cases with ACS of culprit lesions exhibiting optical coherence tomography (OCT)-defined plaque erosion. Additional examinations using near-infrared spectroscopy (NIRS)–intravascular ultrasound and coronary angioscopy suggested the presence of two distinct phenotypes of plaque erosion. These two types of erosion differ in the extent of NIRS-derived lipid core burden and coronary angioscopy-derived luminal surface colour. Discussion OCT-defined plaque erosion may not be the unique entity but have at least two distinct plaque morphologies, and NIRS and/or coronary angioscopy may provide incremental ability of discriminating these plaque phenotypes classified as plaque erosion by OCT.
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Affiliation(s)
- Masao Yamaguchi
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
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61
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Partida RA, Libby P, Crea F, Jang IK. Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. Eur Heart J 2019; 39:2070-2076. [PMID: 29329384 DOI: 10.1093/eurheartj/ehx786] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/17/2017] [Indexed: 12/25/2022] Open
Abstract
Pathology and in vivo imaging studies have identified superficial plaque erosion as a frequent and important mechanism underlying acute coronary syndromes (ACS). In contrast with plaque rupture, the pathophysiological mechanisms leading to plaque erosion remain poorly understood. The advent of intravascular imaging techniques, particularly optical coherence tomography, has aided understanding of this mode of ACS in vivo by complementing previous insights from pathology studies. Appreciation of the distinct biological and clinical mechanisms of plaque erosion points to the possibility of tailored management strategies for patients presenting with ACS.
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Affiliation(s)
- Ramon A Partida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
| | - Peter Libby
- Brigham and Women's Hospital, 77 Ave Louis Pasteur, Boston, MA 02115, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
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62
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Otsuka K, Villiger M, Nadkarni SK, Bouma BE. Intravascular Polarimetry for Tissue Characterization of Coronary Atherosclerosis. Circ Rep 2019; 1:550-557. [PMID: 32432174 PMCID: PMC7236778 DOI: 10.1253/circrep.cr-19-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 01/20/2023] Open
Abstract
The microscopic tissue structure and organization influence the polarization of light. Intravascular polarimetry leverages this compelling intrinsic contrast mechanism by using polarization-sensitive optical frequency domain imaging to measure the polarization properties of the coronary arterial wall. Tissues rich in collagen and smooth muscle cells appear birefringent, while the presence of lipid causes depolarization, offering quantitative metrics related to the presence of important components of coronary atherosclerosis. Here, we review the basic principle, the interpretation of polarization signatures, and first clinical investigations of intravascular polarimetry and discuss how this extension of contemporary intravascular imaging may advance our knowledge and improve clinical practice in the future.
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Affiliation(s)
- Kenichiro Otsuka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Seemantini K Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Brett E Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, United States
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63
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Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fracassi F, Sugiyama T, Lee H, Crea F, Kimura T, Fujimoto JG, Fuster V, Jang IK. Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes. J Am Heart Assoc 2019; 8:e012322. [PMID: 31640466 PMCID: PMC6898801 DOI: 10.1161/jaha.119.012322] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti-thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non-ST-segment elevation-ACS than in ST-segment-elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age <68 years, anterior ischemia, no diabetes mellitus, hemoglobin >15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non-ST-segment elevation-ACS, the probability of plaque erosion increased to 73.1%. Conclusions Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of ACS patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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Affiliation(s)
- Erika Yamamoto
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.,Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Taishi Yonetsu
- Departmant of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine Nara Medical University Kashihara Nara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine Nara Medical University Kashihara Nara Japan
| | - Bryan P Yan
- Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong
| | - Osamu Kurihara
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Science Catholic University of the Sacred Heart Fondazione Policlinico Agostino Gemelli - IRCCS Rome Italy
| | - Takumi Higuma
- Department of Cardiology Hirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Shigeki Kimura
- Division of Cardiology Kameda Medical Center Kamogawa Chiba Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Kanagawa Japan
| | - Junya Ako
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Kanagawa Japan
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine University Hospitals Leuven Leuven Belgium
| | | | - Holger M Nef
- Department of Cardiology University of Giessen Germany
| | - Francesco Fracassi
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Tomoyo Sugiyama
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Hang Lee
- Biostatiscs Center Massachusetts General Hospital Harvard Medical School Boston MA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Science Catholic University of the Sacred Heart Fondazione Policlinico Agostino Gemelli - IRCCS Rome Italy
| | - Takeshi Kimura
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - James G Fujimoto
- Research Laboratory of Electronics Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology Cambridge MA
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Ik-Kyung Jang
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.,Division of Cardiology Kyung Hee University Hospital Seoul Republic of Korea
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64
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Abstract
The mechanisms that underlie superficial erosion, a cause of coronary thrombosis distinct from plaque rupture, have garnered recent interest. In an era of improved control of traditional risk factors, such as LDL (low-density lipoprotein), plaque erosion may assume greater clinical importance. Plaques complicated by erosion tend to be matrix-rich, lipid-poor, and usually lack prominent macrophage collections, unlike plaques that rupture, which characteristically have thin fibrous caps, large lipid pools, and abundant foam cells. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. The pathogenesis of plaque rupture probably does not pertain to superficial erosion, a process heretofore little understood mechanistically. We review here data that support a substantial shift in the mechanisms of the thrombotic complications of atherosclerosis. We further consider pathophysiologic processes recently implicated in the mechanisms of erosion. Multiple processes likely predispose plaques to superficial erosion, including experiencing disturbed flow, basement membrane breakdown, endothelial cell death, and detachment potentiated by innate immune activation mediated through pattern-recognition receptors and endothelial-to-mesenchymal transition. Monocytes/macrophages predominate in the pathogenesis of plaque rupture and consequent thrombosis, but polymorphonuclear leukocytes likely promote endothelial damage during superficial erosion. The formation of neutrophil extracellular traps probably perpetuates and propagates intimal injury and potentiates thrombosis due to superficial erosion. These considerations have profound clinical implications. Acute coronary syndromes because of erosion may not require immediate invasive therapy. Understanding the biological bases of erosion points to novel therapies for acute coronary syndrome caused by erosion. Future research should probe further the mechanisms of superficial erosion, and develop point-of-care tests to distinguish acute coronary syndromes provoked by erosion versus rupture that may direct more precision management. Future clinical investigations should evaluate intervening on the targets that have emerged from experimental studies and the management strategies that they inform.
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Affiliation(s)
- Peter Libby
- From the Cardiology Division of the Brigham and Women's Hospital (P.L.), Harvard Medical School, Boston
| | - Gerard Pasterkamp
- Laboratory Clinical Chemistry, Division LAB, University Medical Center Utrecht, The Netherlands (G.P.)
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, F. Policlinico Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy (F.C.)
| | - Ik-Kyung Jang
- Massachusetts General Hospital (I.-K.J.), Harvard Medical School, Boston
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65
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Kim HO, Kim CJ, Kim W, Cho JM, Soeda T, Takano M, Yan BP, Crea F, Niccoli G, Vergallo R, Minami Y, Higuma T, Kimura S, Boeder NF, Nef H, Adriaenssens T, Kurihara O, Thondapu V, Russo M, Yamamoto E, Sugiyama T, Lee H, Kakuta T, Yonetsu T, Jang IK. Relative risk of plaque erosion among different age and sex groups in patients with acute coronary syndrome. J Thromb Thrombolysis 2019; 49:352-359. [DOI: 10.1007/s11239-019-01969-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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66
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Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
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67
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Immune-Mediated Inflammation in Vulnerable Atherosclerotic Plaques. Molecules 2019; 24:molecules24173072. [PMID: 31450823 PMCID: PMC6749340 DOI: 10.3390/molecules24173072] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023] Open
Abstract
Atherosclerosis is a chronic long-lasting vascular disease leading to myocardial infarction and stroke. Vulnerable atherosclerotic (AS) plaques are responsible for these life-threatening clinical endpoints. To more successfully work against atherosclerosis, improvements in early diagnosis and treatment of AS plaque lesions are required. Vulnerable AS plaques are frequently undetectable by conventional imaging because they are non-stenotic. Although blood biomarkers like lipids, C-reactive protein, interleukin-6, troponins, and natriuretic peptides are in pathological ranges, these markers are insufficient in detecting the critical perpetuation of AS anteceding endpoints. Thus, chances to treat the patient in a preventive way are wasted. It is now time to solve this dilemma because clear results indicate a benefit of anti-inflammatory therapy per se without modification of blood lipids (CANTOS Trial, NCT01327846). This fact identifies modulation of immune-mediated inflammation as a new promising point of action for the eradication of fatal atherosclerotic endpoints.
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68
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Hou FJ, Zhou YJ, Ma XT, He T, Yan RQ, Geng Q, Wang HY, Ma Y, Ren YQ, Dong FZ. Culprit Lesion Characteristics in Young Patients with Hyperhomocysteinemia. Med Sci Monit 2019; 25:5306-5311. [PMID: 31313754 PMCID: PMC6659466 DOI: 10.12659/msm.914979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The relationships between culprit coronary plaque characteristics and hyperhomocysteinemia (HHcy) are not fully understood in young patients. In this study we investigated the relationship between culprit atherosclerotic plaque phenotype assessed by optical coherence tomography (OCT) and hyperhomocysteinemia (HHcy) in young patients. Material/Methods We investigated the OCT imaging and HHcy of 123 lesions in 123 young patients (≤45 years of age). According to OCT images, culprit lesions were classified as thin-cap fiber atheroma (TCFA), thrombus, and other. The 123 patients were grouped as: HHcy group (53 cases, HHcy ≥15.5 μmol/l) and control group (70 cases, HHcy <15.5 μmol/l). Results Compared with the control group, the HHcy group had a higher proportion of OCT-TCFA (p=0.03), OCT-vasa vasorum (p=0.013), and OCT-thrombus (p=0.012), and a larger lipid arc (p=0.002). HHcy (P=0.037) and metabolic syndrome (MetS) (P=0.016) remained independent predictors of TCFAs. HHcy (P=0.026) and smoking (P=0.005) remained independent determinants of thrombus. Conclusions HHcy and MetS are associated with TCFAs, and HHcy and smoking are associated with thrombus in young patients with coronary artery disease.
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Affiliation(s)
- Fang-Jie Hou
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, China (mainland).,Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Yu-Jie Zhou
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, China (mainland)
| | - Xiao-Teng Ma
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, China (mainland)
| | - Tao He
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Rong-Qiang Yan
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Qiang Geng
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Hai-Yang Wang
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Ying Ma
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Yong-Qiang Ren
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
| | - Fu-Zong Dong
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, Shandong, China (mainland)
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69
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Kitahara S, Kataoka Y, Otsuka F, Hosoda H, Asaumi Y, Noguchi T, Yasuda S. Plaque erosion or coronary artery embolism? Findings from clinical presentation, optical coherence tomographic and histopathological analysis in a case with acute coronary syndrome. Int J Cardiovasc Imaging 2019; 35:1791-1792. [PMID: 31172391 DOI: 10.1007/s10554-019-01641-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Yu Kataoka
- National Cerebral and Cardiovascular Center, Suita, Japan.
| | | | - Hayato Hosoda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
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70
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Bode MF, Jaffer FA. IVUS and OCT: Current State-of-the-Art in Intravascular Coronary Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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71
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Libby P. Superficial erosion and the precision management of acute coronary syndromes: not one-size-fits-all. Eur Heart J 2019; 38:801-803. [PMID: 28053187 DOI: 10.1093/eurheartj/ehw599] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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72
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Sato N, Minami Y, Shimohama T, Kameda R, Tojo T, Ako J. Vascular response and intrastent thrombus in the early phase after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: An observational, single-center study. Health Sci Rep 2019; 2:e105. [PMID: 30697598 PMCID: PMC6346990 DOI: 10.1002/hsr2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Second-generation drug-eluting stents (G2-DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare-metal stent (BMS) in the setting of ST-segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2-DES and BMS in early-phase STEMI. METHODS Between May 2010 and August 2014, a total of 41 STEMI patients treated by either G2-DES (n = 26; everolimus-eluting stent [EES]: n = 15, zotarolimus-eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation. RESULTS Baseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, P = 0.01, t test), were comparable between patients with drug-eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, P = 0.88, χ 2 test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), P = 0.04, Mann-Whitney U test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, P = 0.07, Mann-Whitney U test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, P = 0.45, Mann-Whitney U test). No significant difference in thrombus burden was observed between EES and ZES. CONCLUSIONS Thrombus burden was significantly smaller with DES than with BMS at 1-month follow-up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2-DES that has previously been reported in the literature.
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Affiliation(s)
- Nobuhiro Sato
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Yoshiyasu Minami
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Takao Shimohama
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Ryo Kameda
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Taiki Tojo
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
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73
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Chieffo A, Buchanan GL, Mehilli J, Capodanno D, Kunadian V, Petronio AS, Mikhail GW, Capranzano P, Gonzal N, Karam N, Manzo-Silberman S, Schüpke S, Byrne RA, Capretti G, Appelman Y, Morice MC, Presbitero P, Radu M, Mauri J. Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee. EUROINTERVENTION 2018; 14:e1227-e1235. [PMID: 29786536 DOI: 10.4244/eij-d-18-00225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.
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74
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Sato A. Plaque erosion is a predictable clinical entity and tailored management in patients with ST-segment elevation myocardial infarction. J Thorac Dis 2018; 10:S3274-S3275. [PMID: 30370135 DOI: 10.21037/jtd.2018.08.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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75
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[MINOCA-myocardial infarction with non-obstructive coronary arteries]. Herz 2018; 43:759-770. [PMID: 30328479 DOI: 10.1007/s00059-018-4756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In recent years it has been observed with increasing interest that there is a group of patients with electrocardiographic and laboratory features of myocardial infarction (MI) but no obstructive coronary artery disease (<50% diameter stenosis). For this entity the term myocardial infarction with non-obstructive coronary arteries (MINOCA) has been coined. The prevalence of MINOCA is estimated to be 6-9% among patients diagnosed with MI and it is more common in women than men as well as in patients presenting with NSTEMI than in those presenting with STEMI. The MINOCA is a working diagnosis that requires a further diagnostic work-up by invasive techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) or non-invasive imaging with cardiac magnetic resonance imaging (CMRI). When it is ascertained that obstructive coronary artery disease has not been inadvertently overlooked, other coronary disorders, such as plaque rupture or erosion, thrombosis, dissection, spasms or microvascular dysfunction should be evaluated. Furthermore, myocarditis or tako-tsubo cardiomyopathy should be excluded by CMRI as non-coronary causes. The further treatment and prognosis of patients with MINOCA depend on the underlying cause and the final diagnosis.
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Roule V, Briet C, Lemaitre A, Ardouin P, Bignon M, Sabatier R, Blanchart K, Beygui F. Plaque erosion versus rupture characterization by optical frequency domain imaging before and after coronary stenting following successful fibrinolysis for ST-segment elevation myocardial infarction. Heart Vessels 2018; 34:401-409. [PMID: 30191317 DOI: 10.1007/s00380-018-1258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
Intracoronary thrombus burden affects the quality of myocardial reperfusion in the setting of ST-elevation myocardial infarction (STEMI). We aimed to study the characteristics of the plaque and thrombus assessed by intracoronary optical frequency domain imaging (OFDI) according to the presence of plaque rupture or erosion in STEMI patients treated with successful fibrinolysis. Pre-stenting thrombus and post-stenting atherothrombotic burden were compared between plaque rupture and erosion. Twenty-seven consecutive patients were included: 17 (63%) had OFDI-plaque rupture and 10 (37%) had OFDI-erosion. Thrombus volume and burden were significantly higher in case of rupture compared to erosion at baseline (13.4 ± 18.4 vs 2.8 ± 2.3 mm3; p = 0.03 and 33.8 ± 17.5 vs 17.5 ± 9.9%; p = 0.007, respectively). In the rupture group, the core of the thrombus consisted dominantly of red thrombus evenly distributed along the entire culprit plaque. In the erosion group, it consisted dominantly of white thrombus with a focal distribution near the minimal lumen area zone. After stenting, the atherothrombotic volume, burden and its distribution, as well as angiographic estimators of myocardial reperfusion were similar between groups. Our study showed that pre-PCI thrombus amount, typesetting and distribution are mainly linked to the underlying mechanism of STEMI. After stenting, the atherothrombotic burden and its distribution were similar between the groups.
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Affiliation(s)
- Vincent Roule
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,EA 4650, Normandie Université-Caen, Caen, France.
| | - Clément Briet
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Farzin Beygui
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,EA 4650, Normandie Université-Caen, Caen, France
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Libby P. Seeing and Sampling the Surface of the Atherosclerotic Plaque: Red or White Can Make Blue. Arterioscler Thromb Vasc Biol 2018; 36:2275-2277. [PMID: 27879273 DOI: 10.1161/atvbaha.116.308491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Libby
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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78
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Gonzalo N. Acute coronary syndromes: time to go further. EUROINTERVENTION 2018; 14:616-618. [DOI: 10.4244/eijv14i6a109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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79
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Clozapine-Induced Myocarditis or Acute Coronary Syndrome? Optical Coherence Tomography to the Rescue. Case Rep Cardiol 2018; 2018:5026107. [PMID: 30116643 PMCID: PMC6079512 DOI: 10.1155/2018/5026107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/09/2018] [Indexed: 12/02/2022] Open
Abstract
Chest pain and troponin elevation may be due to an acute coronary syndrome, myocarditis, acute cardiomyopathy, or other less common conditions. Management differs depending on the aetiology, and the pathophysiologic diagnosis has direct implications on treatment and patient outcomes. History and clinical examination is supplemented by selected investigations including the electrocardiogram, chest X-ray, echocardiography, coronary angiography, and even myocardial perfusion scintigraphy or cardiac magnetic resonance imaging. Intravascular imaging can provide important insights into the underlying mechanism of acute coronary syndromes, especially when angiography is ambiguous.
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80
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Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 2018; 33:178-203. [PMID: 29594964 PMCID: PMC5880864 DOI: 10.1007/s12928-018-0516-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/28/2022]
Abstract
While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.,Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Satoru Otsuji
- Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Takafumi Ueno
- Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kinzo Ueda
- Rakuwakai Kyoto Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | | | | | - Eisho Kyo
- Kusatsu Heart Center, Kusatsu, Japan
| | | | | | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | | | | | | | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Michishita
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
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81
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Franck G, Mawson TL, Folco EJ, Molinaro R, Ruvkun V, Engelbertsen D, Liu X, Tesmenitsky Y, Shvartz E, Sukhova GK, Michel JB, Nicoletti A, Lichtman A, Wagner D, Croce KJ, Libby P. Roles of PAD4 and NETosis in Experimental Atherosclerosis and Arterial Injury: Implications for Superficial Erosion. Circ Res 2018; 123:33-42. [PMID: 29572206 DOI: 10.1161/circresaha.117.312494] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE Neutrophils likely contribute to the thrombotic complications of human atheromata. In particular, neutrophil extracellular traps (NETs) could exacerbate local inflammation and amplify and propagate arterial intimal injury and thrombosis. PAD4 (peptidyl arginine deiminase 4) participates in NET formation, but an understanding of this enzyme's role in atherothrombosis remains scant. OBJECTIVE This study tested the hypothesis that PAD4 and NETs influence experimental atherogenesis and in processes implicated in superficial erosion, a form of plaque complication we previously associated with NETs. METHODS AND RESULTS Bone marrow chimeric Ldlr deficient mice reconstituted with either wild-type or PAD4-deficient cells underwent studies that assessed atheroma formation or procedures designed to probe mechanisms related to superficial erosion. PAD4 deficiency neither retarded fatty streak formation nor reduced plaque size or inflammation in bone marrow chimeric mice that consumed an atherogenic diet. In contrast, either a PAD4 deficiency in bone marrow-derived cells or administration of DNaseI to disrupt NETs decreased the extent of arterial intimal injury in mice with arterial lesions tailored to recapitulate characteristics of human atheroma complicated by erosion. CONCLUSIONS These results indicate that PAD4 from bone marrow-derived cells and NETs do not influence chronic experimental atherogenesis, but participate causally in acute thrombotic complications of intimal lesions that recapitulate features of superficial erosion.
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Affiliation(s)
- Grégory Franck
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.).,Brigham and Women's Hospital, Harvard Medical School, Boston, MA; INSERM U1148, Laboratory for Vascular Translational Science (LVTS), Paris, France (G.F., J.-B.M., A.N.)
| | - Thomas L Mawson
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Eduardo J Folco
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Roberto Molinaro
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Victoria Ruvkun
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | | | - Xin Liu
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Yevgenia Tesmenitsky
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Eugenia Shvartz
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Galina K Sukhova
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Jean-Baptiste Michel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA; INSERM U1148, Laboratory for Vascular Translational Science (LVTS), Paris, France (G.F., J.-B.M., A.N.)
| | - Antonino Nicoletti
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA; INSERM U1148, Laboratory for Vascular Translational Science (LVTS), Paris, France (G.F., J.-B.M., A.N.)
| | | | - Denisa Wagner
- Division of Hematology/Oncology, Boston Children's Hospital, MA (D.W.)
| | - Kevin J Croce
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
| | - Peter Libby
- From the Department of Cardiovascular Medicine (G.F., T.L.M., E.J.F., R.M., V.R., X.L., Y.T., E.S., G.K.S., K.J.C., P.L.)
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82
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Sugiyama T, Yamamoto E, Bryniarski K, Xing L, Lee H, Isobe M, Libby P, Jang IK. Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture: A 3-Vessel Optical Coherence Tomography Study. JAMA Cardiol 2018; 3:207-214. [PMID: 29417141 PMCID: PMC5885886 DOI: 10.1001/jamacardio.2017.5234] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/30/2017] [Indexed: 01/12/2023]
Abstract
Importance Patients with culprit plaque rupture are known to have pancoronary plaque vulnerability. However, the characteristics of nonculprit plaques in patients with acute coronary syndromes caused by plaque erosion are unknown. Objective To investigate the nonculprit plaque phenotype in patients with acute coronary syndrome according to culprit plaque pathology (erosion vs rupture) by 3-vessel optical coherence tomography imaging. Design, Setting, and Participants In this observational cohort study, between August 2010 and May 2014, 82 patients with acute coronary syndrome who underwent preintervention optical coherence tomography imaging of all 3 major epicardial coronary arteries were enrolled at the Massachusetts General Hospital Optical Coherence Tomography Registry database. Analysis of the data was conducted between November 2016 and July 2017. Patients were classified into 2 groups based on the culprit lesion pathology: 17 patients with culprit plaque erosion and 34 patients with culprit plaque rupture. Thirty-one patients with the absence of culprit rupture or erosion were excluded from further analysis. Exposures Preintervention 3-vessel optical coherence tomography imaging. Main Outcomes and Measures Plaque characteristics at the culprit and nonculprit lesions evaluated by optical coherence tomography. Results In 51 patients (37 men; mean age, 58.7 years), the characteristics of 51 culprit plaques and 216 nonculprit plaques were analyzed. In patients with culprit erosion, the mean (SD) number of nonculprit plaques per patient was smaller (3.4 [1.9] in erosion vs 4.7 [2.1] in rupture, P = .05). Patient-based analysis showed that none of 17 patients with culprit plaque erosion had nonculprit plaque rupture, whereas 26% of the patients (9 of 34) with culprit plaque rupture had nonculprit plaque rupture (P = .02). Plaque-based analysis showed that, compared with the culprit rupture group (n = 158), the culprit erosion group (n = 58) had lower prevalence of plaque rupture (0% vs 8%; P < .001), macrophage accumulation (29% vs 53%; P = .01), microvessels (21% vs 42%; P = .003), and spotty calcium (5% vs 22%; P = .006) in the nonculprit lesions. The prevalence of lipid-rich plaque, thin-cap fibroatheroma, and thrombus did not differ between the groups. Conclusions and Relevance Compared with those with culprit plaque rupture, patients with acute coronary syndrome caused by culprit plaque erosion had a smaller number of nonculprit plaques and the lower levels of panvascular instability, affirming that distinct pathophysiologic mechanisms operate in plaque erosion and plaque rupture.
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Affiliation(s)
- Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erika Yamamoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krzysztof Bryniarski
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lei Xing
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Kyung Hee University Hospital, Seoul, Republic of Korea
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83
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Sakamoto A, Virmani R, Finn AV, Gupta A. Calcified Nodule as the Cause of Acute Coronary Syndrome: Connecting Bench Observations to the Bedside. Cardiology 2018; 139:101-104. [DOI: 10.1159/000485119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
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84
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Yonetsu T, Jang IK. Advances in Intravascular Imaging: New Insights into the Vulnerable Plaque from Imaging Studies. Korean Circ J 2017; 48:1-15. [PMID: 29171202 PMCID: PMC5764866 DOI: 10.4070/kcj.2017.0182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Abstract
The term “vulnerable plaque” denotes the plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: plaque rupture, plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone plaque have been extensively studied. Pathology studies have identified the features of rupture-prone plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify vulnerable plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of vulnerable plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ik Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Kyung-Hee University Hospital, Seoul, Korea.
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85
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Abstract
Well into the 21st century, we still triage acute myocardial infarction on the basis of the presence or absence of ST-segment elevation, a century-old technology. Meanwhile, we have learned a great deal about the pathophysiology and mechanisms of acute coronary syndromes (ACS) at the clinical, pathological, cellular, and molecular levels. Contemporary imaging studies have shed new light on the mechanisms of ACS. This review discusses these advances and their implications for clinical management of the ACS for the future. Plaque rupture has dominated our thinking about ACS pathophysiology for decades. However, current evidence suggests that a sole focus on plaque rupture vastly oversimplifies this complex collection of diseases and obscures other mechanisms that may mandate different management strategies. We propose segmenting coronary artery thrombosis caused by plaque rupture into cases with or without signs of concomitant inflammation. This distinction may have substantial therapeutic implications as direct anti-inflammatory interventions for atherosclerosis emerge. Coronary artery thrombosis caused by plaque erosion may be on the rise in an era of intense lipid lowering. Identification of patients with of ACS resulting from erosion may permit a less invasive approach to management than the current standard of care. We also now recognize ACS that occur without apparent epicardial coronary artery thrombus or stenosis. Such events may arise from spasm, microvascular disease, or other pathways. Emerging management strategies may likewise apply selectively to this category of ACS. We advocate this more mechanistic approach to the categorization of ACS to provide a framework for future tailoring, triage, and therapy for patients in a more personalized and precise manner.
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Affiliation(s)
- Filippo Crea
- From Department of Cardiovascular and Thoracic Sciences, Catholic University, Rome, Italy (F.C.); and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.)
| | - Peter Libby
- From Department of Cardiovascular and Thoracic Sciences, Catholic University, Rome, Italy (F.C.); and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.).
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86
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Abstract
PURPOSE OF REVIEW The present review explores the mechanisms of superficial intimal erosion, a common cause of thrombotic complications of atherosclerosis. RECENT FINDINGS Human coronary artery atheroma that give rise to thrombosis because of erosion differ diametrically from those associated with fibrous cap rupture. Eroded lesions characteristically contain few inflammatory cells, abundant extracellular matrix, and neutrophil extracellular traps (NETs). Innate immune mechanisms such as engagement of Toll-like receptor 2 (TLR2) on cultured endothelial cells can impair their viability, attachment, and ability to recover a wound. Hyaluronan fragments may serve as endogenous TLR2 ligands. Mouse experiments demonstrate that flow disturbance in arteries with neointimas tailored to resemble features of human eroded plaques disturbs endothelial cell barrier function, impairs endothelial cell viability, recruits neutrophils, and provokes endothelial cells desquamation, NET formation, and thrombosis in a TLR2-dependent manner. SUMMARY Mechanisms of erosion have received much less attention than those that provoke plaque rupture. Intensive statin treatment changes the characteristic of plaques that render them less susceptible to rupture. Thus, erosion may contribute importantly to the current residual burden of risk. Understanding the mechanisms of erosion may inform the development and deployment of novel therapies to combat the remaining atherothrombotic risk in the statin era.
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Affiliation(s)
- Thibaut Quillard
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Grégory Franck
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Thomas Mawson
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Eduardo Folco
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Peter Libby
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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87
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Double trouble with acute inferior myocardial infarction and left anterior descending artery thrombi. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2017. [DOI: 10.1016/j.ijcac.2016.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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88
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Recurrent acute coronary syndrome and mechanisms of plaque instability. Int J Cardiol 2017; 243:98-102. [DOI: 10.1016/j.ijcard.2017.05.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
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89
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Liu S, Sotomi Y, Eggermont J, Nakazawa G, Torii S, Ijichi T, Onuma Y, Serruys PW, Lelieveldt BPF, Dijkstra J. Tissue characterization with depth-resolved attenuation coefficient and backscatter term in intravascular optical coherence tomography images. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-16. [PMID: 28901053 DOI: 10.1117/1.jbo.22.9.096004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/21/2017] [Indexed: 05/08/2023]
Abstract
An important application of intravascular optical coherence tomography (IVOCT) for atherosclerotic tissue analysis is using it to estimate attenuation and backscatter coefficients. This work aims at exploring the potential of the attenuation coefficient, a proposed backscatter term, and image intensities in distinguishing different atherosclerotic tissue types with a robust implementation of depth-resolved (DR) approach. Therefore, the DR model is introduced to estimate the attenuation coefficient and further extended to estimate the backscatter-related term in IVOCT images, such that values can be estimated per pixel without predefining any delineation for the estimation. In order to exclude noisy regions with a weak signal, an automated algorithm is implemented to determine the cut-off border in IVOCT images. The attenuation coefficient, backscatter term, and the image intensity are further analyzed in regions of interest, which have been delineated referring to their pathology counterparts. Local statistical values were reported and their distributions were further compared with a two-sample t-test to evaluate the potential for distinguishing six types of tissues. Results show that the IVOCT intensity, DR attenuation coefficient, and backscatter term extracted with the reported implementation are complementary to each other on characterizing six tissue types: mixed, calcification, fibrous, lipid-rich, macrophages, and necrotic core.
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Affiliation(s)
- Shengnan Liu
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Yohei Sotomi
- University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeroen Eggermont
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Gaku Nakazawa
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Sho Torii
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Takeshi Ijichi
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardialysis, Rotterdam, The Netherlands
| | - Patrick W Serruys
- International Centre for Circulatory Health, the National Heart and Lung Institute, Imperial College, United Kingdom
| | - Boudewijn P F Lelieveldt
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
- Delft University of Technology, Department of Intelligent Systems, Delft, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
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90
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Wang X, Xie Z, Liu X, Huang X, Lin J, Huang D, Yu B, Hou J. Association of Platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome: an optical coherence tomography study. BMC Cardiovasc Disord 2017; 17:175. [PMID: 28673240 PMCID: PMC5496410 DOI: 10.1186/s12872-017-0618-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/27/2017] [Indexed: 01/09/2023] Open
Abstract
Background The platelet to lymphocyte ratio (PLR), an indirect inflammatory biomarker, has been recently demonstrated to be associated with severity of coronary artery disease. In the present study, we sought to investigate whether PLR is associated with vulnerable plaque characteristics of non-culprit lesions in patients with acute coronary syndrome (ACS). Methods The patients in our study were divided into two groups (high PLR group and low PLR group). A total of 119 non-culprit plaques from 71 patients with ACS were assessed by optical coherence tomography (OCT). Results The non-culprit plaques in high PLR group exhibited thinner fibrous cap thickness (FCT) (88.60 ± 44.70 vs. 119.28 ± 50.22 μm, P = 0.001), greater maximum lipid arc (271.73 ± 71.66 vs. 240.60 ± 76.69°, P = 0.027) and increased incidence of thin-cap fibroatheroma (TCFA) (34.0% vs. 15.9%, P = 0.022) compared with those in low PLR group. Meanwhile, PLR was negatively associated with FCT (r = −0.329, P < 0.001). Furthermore, multivariate regression analysis showed that PLR [OR: 1.023 (95% CI: 1.005–1.041), P = 0.012] and LDL-C [OR: 1.892 (95% CI: 1.106–3.239), P = 0.020] were significant predictors of TCFA. Conclusions High level of PLR may be associated with vulnerable plaque features of non-culprit lesions in patients with ACS. PLR, a cheap and easily available index, may surve as a useful inflammatory marker in reflecting plaque vulnerability.
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Affiliation(s)
- Xuedong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Zulong Xie
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xinxin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Xingtao Huang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Jiale Lin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Dan Huang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China. .,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China.
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91
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Szilágyi SM, Popovici MM, Szilágyi L. Review. Automatic Segmentation Techniques of the Coronary Artery Using CT Images in Acute Coronary Syndromes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Coronary artery disease represents one of the leading reasons of death worldwide, and acute coronary syndromes are their most devastating consequences. It is extremely important to identify the patients at risk for developing an acute myocardial infarction, and this goal can be achieved using noninvasive imaging techniques. Coronary computed tomography angiography (CCTA) is currently one of the most reliable methods used for assessing the coronary arteries; however, its use in emergency settings is sometimes limited due to time constraints. This paper presents the main characteristics of plaque vulnerability, the role of CCTA in the assessment of vulnerable plaques, and automatic segmentation techniques of the coronary artery tree based on CT angiography images. A detailed inventory of existing methods is given, representing the state-of-the-art of computational methods applied in vascular system segmentation, focusing on the current applications in acute coronary syndromes.
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Affiliation(s)
| | - Monica Marton Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, 21601, 76th Ave W, Edmonds, Washington , 98026, USA
| | - László Szilágyi
- Department of Electrical Engineering, Sapientia University, Tîrgu Mureș , Romania
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92
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Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction: a multicenter randomized clinical trial. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2017; 14:108-117. [PMID: 28491085 PMCID: PMC5409352 DOI: 10.11909/j.issn.1671-5411.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction (STEMI) patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a prospective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate (40%–70%) stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban (15 µg/kg) were enrolled and were randomly assigned (1: 1) to stenting group (n = 201) and non-stenting group (n = 198). In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention (PCI) with stent implantation. In non-stenting group, patients received pharmacologic therapy and PCI (thrombectomy), but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiac death, non-fatal myocardial infarction (MI), repeat revascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complication. Median follow-up time was 12.4 ± 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group (adjusted HR: 0.42, 95% CI: 0.19–0.89, P = 0.02). The stenting group had lower non-fatal MI rate than non-stenting group, (1.5% vs. 5.5%, P = 0.03). The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.
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93
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Chandran S, Watkins J, Abdul-Aziz A, Shafat M, Calvert PA, Bowles KM, Flather MD, Rushworth SA, Ryding AD. Inflammatory Differences in Plaque Erosion and Rupture in Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.005868. [PMID: 28468787 PMCID: PMC5524113 DOI: 10.1161/jaha.117.005868] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Plaque erosion causes 30% of ST‐segment elevation myocardial infarctions, but the underlying cause is unknown. Inflammatory infiltrates are less abundant in erosion compared with rupture in autopsy studies. We hypothesized that erosion and rupture are associated with significant differences in intracoronary cytokines in vivo. Methods and Results Forty ST‐segment elevation myocardial infarction patients with <6 hours of chest pain were classified as ruptured fibrous cap (RFC) or intact fibrous cap (IFC) using optical coherence tomography. Plasma samples from the infarct‐related artery and a peripheral artery were analyzed for expression of 102 cytokines using arrays; results were confirmed with ELISA. Thrombectomy samples were analyzed for differential mRNA expression using quantitative real‐time polymerase chain reaction. Twenty‐three lesions were classified as RFC (58%), 15 as IFC (38%), and 2 were undefined (4%). In addition, 12% (12 of 102) of cytokines were differentially expressed in both coronary and peripheral plasma. I‐TAC was preferentially expressed in RFC (significance analysis of microarrays adjusted P<0.001; ELISA IFC 10.2 versus RFC 10.8 log2 pg/mL; P=0.042). IFC was associated with preferential expression of epidermal growth factor (significance analysis of microarrays adjusted P<0.001; ELISA IFC 7.42 versus RFC 6.63 log2 pg/mL, P=0.036) and thrombospondin 1 (significance analysis of microarrays adjusted P=0.03; ELISA IFC 10.4 versus RFC 8.65 log2 ng/mL, P=0.0041). Thrombectomy mRNA showed elevated I‐TAC in RFC (P=0.0007) epidermal growth factor expression in IFC (P=0.0264) but no differences in expression of thrombospondin 1. Conclusions These results demonstrate differential intracoronary cytokine expression in RFC and IFC. Elevated thrombospondin 1 and epidermal growth factor may play an etiological role in erosion.
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Affiliation(s)
- Sujay Chandran
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - Amina Abdul-Aziz
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Manar Shafat
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Patrick A Calvert
- Papworth Hospital NHS Foundation Trust, Papworth Everard Cambridge, United Kingdom
| | - Kristian M Bowles
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Marcus D Flather
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stuart A Rushworth
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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94
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Franck G, Mawson T, Sausen G, Salinas M, Masson GS, Cole A, Beltrami-Moreira M, Chatzizisis Y, Quillard T, Tesmenitsky Y, Shvartz E, Sukhova GK, Swirski FK, Nahrendorf M, Aikawa E, Croce KJ, Libby P. Flow Perturbation Mediates Neutrophil Recruitment and Potentiates Endothelial Injury via TLR2 in Mice: Implications for Superficial Erosion. Circ Res 2017; 121:31-42. [PMID: 28428204 DOI: 10.1161/circresaha.117.310694] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/10/2017] [Accepted: 04/20/2017] [Indexed: 01/25/2023]
Abstract
RATIONALE Superficial erosion currently causes up to a third of acute coronary syndromes; yet, we lack understanding of its mechanisms. Thrombi because of superficial intimal erosion characteristically complicate matrix-rich atheromata in regions of flow perturbation. OBJECTIVE This study tested in vivo the involvement of disturbed flow and of neutrophils, hyaluronan, and Toll-like receptor 2 ligation in superficial intimal injury, a process implicated in superficial erosion. METHODS AND RESULTS In mouse carotid arteries with established intimal lesions tailored to resemble the substrate of human eroded plaques, acute flow perturbation promoted downstream endothelial cell activation, neutrophil accumulation, endothelial cell death and desquamation, and mural thrombosis. Neutrophil loss-of-function limited these findings. Toll-like receptor 2 agonism activated luminal endothelial cells, and deficiency of this innate immune receptor decreased intimal neutrophil adherence in regions of local flow disturbance, reducing endothelial cell injury and local thrombosis (P<0.05). CONCLUSIONS These results implicate flow disturbance, neutrophils, and Toll-like receptor 2 signaling as mechanisms that contribute to superficial erosion, a cause of acute coronary syndrome of likely growing importance in the statin era.
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Affiliation(s)
- Grégory Franck
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Thomas Mawson
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Grasiele Sausen
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Manuel Salinas
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Gustavo Santos Masson
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Andrew Cole
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Marina Beltrami-Moreira
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Yiannis Chatzizisis
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Thibault Quillard
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Yevgenia Tesmenitsky
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Eugenia Shvartz
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Galina K Sukhova
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Filip K Swirski
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Matthias Nahrendorf
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Elena Aikawa
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Kevin J Croce
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.)
| | - Peter Libby
- From the Department of Cardiovascular Medicine (G.F., T.M., G.S., M.S., A.C., M.B.-M., Y.C., T.Q., Y.T., E.S., G.K.S., E.A., K.J.C., P.L.), and Center for Interdisciplinary Cardiovascular Sciences (E.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.M., F.K.S., M.N.); and Department of Engineering and Technology, College of Engineering and Computing, Nova Southeastern University, Fort Lauderdale, FL (M.S.).
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95
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Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
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96
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Seto AH, Dehghani P, Shah B, Anwaruddin S, Safirstein J, Tremmel JA. Late breaking trials of 2016 in coronary artery disease: Commentary covering SCAI, ACC, TCT, EuroPCR, ESC, and AHA. Catheter Cardiovasc Interv 2017; 89:1028-1034. [PMID: 28276150 DOI: 10.1002/ccd.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 11/06/2022]
Abstract
The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2016, including SCAI, ACC, TCT, EuroPCR, ESC, and AHA. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Binita Shah
- Veterans Affairs New York Harbor Health Care System, New York University School of Medicine, New York, New York
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan Safirstein
- Department of Cardiology, The Gagnon Cardiovascular Institute at the Morristown Memorial Hospital, Morristown, New Jersey
| | - Jennifer A Tremmel
- Department of Medicine (Cardiovascular), Stanford University Medical Center, Stanford, California
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97
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Hu S, Zhu Y, Zhang Y, Dai J, Li L, Dauerman H, Soeda T, Wang Z, Lee H, Wang C, Zhe C, Wang Y, Zheng G, Zhang S, Jia H, Yu B, Jang IK. Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study. J Am Heart Assoc 2017; 6:JAHA.116.004730. [PMID: 28235809 PMCID: PMC5524007 DOI: 10.1161/jaha.116.004730] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. Methods and Results We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%, P<0.001), thrombus (59.4% versus 14.6%, P<0.001), and protrusion (93.8% versus 73.2%, P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1‐year follow‐up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events. Conclusions Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.
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Affiliation(s)
- Sining Hu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yinchun Zhu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yingying Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiannan Dai
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lulu Li
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Harold Dauerman
- Division of Cardiology, University of Vermont College of Medicine/Fletcher Allen Healthcare, Burlington, VT
| | | | - Zhao Wang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Hang Lee
- Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Chao Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chunyang Zhe
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yan Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Gonghui Zheng
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shaosong Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China .,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China .,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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98
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Tenekecioglu E, Albuquerque FN, Sotomi Y, Zeng Y, Suwannasom P, Tateishi H, Cavalcante R, Ishibashi Y, Nakatani S, Abdelghani M, Dijkstra J, Bourantas C, Collet C, Karanasos A, Radu M, Wang A, Muramatsu T, Landmesser U, Okamura T, Regar E, Räber L, Guagliumi G, Pyo RT, Onuma Y, Serruys PW. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview. Catheter Cardiovasc Interv 2017; 89:679-689. [DOI: 10.1002/ccd.26920] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Erhan Tenekecioglu
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Felipe N. Albuquerque
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine; Atlanta United States
| | - Yohei Sotomi
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Yaping Zeng
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Pannipa Suwannasom
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Hiroki Tateishi
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Rafael Cavalcante
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Yuki Ishibashi
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Shimpei Nakatani
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | | | - Jouke Dijkstra
- Leiden University Medical Center; Leiden The Netherlands
| | | | - Carlos Collet
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Antonios Karanasos
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Maria Radu
- Copenhagen University Hospital; Copenhagen Denmark
| | - Ancong Wang
- Leiden University Medical Center; Leiden The Netherlands
| | | | | | | | - Evelyn Regar
- Department of Cardiovascular Surgery; University Hospital Zürich; Switzerland
| | | | | | - Robert T. Pyo
- Albert Einstein College of Medicine; Montefiore Medical Center; NY
| | - Yoshinobu Onuma
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Patrick W. Serruys
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
- International Centre for Circulatory Health, Imperial College; London United Kingdom
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Sugiyama T, Jang IK. Optical Coherence Tomography for Study of In Vivo Pathobiology and for Optimization of Percutaneous Coronary Intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.15791/angioscopy.re.17.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
- Division of Cardiology, Kyung Hee University Hospital
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100
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Fernández-Ruiz I. Plaque erosion — antithrombotics without stenting. Nat Rev Cardiol 2016; 13:636. [DOI: 10.1038/nrcardio.2016.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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