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Gu SZ, Huang Y, Costopoulos C, Jessney B, Bourantas C, Teng Z, Losdat S, Maehara A, Räber L, Stone GW, Bennett MR. Heterogeneous plaque-lumen geometry is associated with major adverse cardiovascular events. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead038. [PMID: 37143612 PMCID: PMC10152392 DOI: 10.1093/ehjopen/oead038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
Aims Prospective studies show that only a minority of plaques with higher risk features develop future major adverse cardiovascular events (MACE), indicating the need for more predictive markers. Biomechanical estimates such as plaque structural stress (PSS) improve risk prediction but require expert analysis. In contrast, complex and asymmetric coronary geometry is associated with both unstable presentation and high PSS, and can be estimated quickly from imaging. We examined whether plaque-lumen geometric heterogeneity evaluated from intravascular ultrasound affects MACE and incorporating geometric parameters enhances plaque risk stratification. Methods and results We examined plaque-lumen curvature, irregularity, lumen aspect ratio (LAR), roughness, PSS, and their heterogeneity indices (HIs) in 44 non-culprit lesions (NCLs) associated with MACE and 84 propensity-matched no-MACE-NCLs from the PROSPECT study. Plaque geometry HI were increased in MACE-NCLs vs. no-MACE-NCLs across whole plaque and peri-minimal luminal area (MLA) segments (HI curvature: adjusted P = 0.024; HI irregularity: adjusted P = 0.002; HI LAR: adjusted P = 0.002; HI roughness: adjusted P = 0.004). Peri-MLA HI roughness was an independent predictor of MACE (hazard ratio: 3.21, P < 0.001). Inclusion of HI roughness significantly improved the identification of MACE-NCLs in thin-cap fibroatheromas (TCFA, P < 0.001), or with MLA ≤ 4 mm2 (P < 0.001), or plaque burden (PB) ≥ 70% (P < 0.001), and further improved the ability of PSS to identify MACE-NCLs in TCFA (P = 0.008), or with MLA ≤ 4 mm2 (P = 0.047), and PB ≥ 70% (P = 0.003) lesions. Conclusion Plaque-lumen geometric heterogeneity is increased in MACE vs. no-MACE-NCLs, and inclusion of geometric heterogeneity improves the ability of imaging to predict MACE. Assessment of geometric parameters may provide a simple method of plaque risk stratification.
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Affiliation(s)
- Sophie Z Gu
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
| | - Yuan Huang
- Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, 20 Clarkson Road, Cambridge CB3 0EH, UK
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Charis Costopoulos
- Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge CB2 0AY, UK
| | - Benn Jessney
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
| | - Christos Bourantas
- Institute of Cardiovascular Sciences, University College London, 62 Huntley Street, London WC1E 6DD, UK
| | - Zhongzhao Teng
- Tenoke Ltd., Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0AH, UK
- Nanjing Jingsan Medical Science and Technology Ltd., 6 Shui You Gang, Nanjing, Jiangsu 210013, China
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, NY 10029, USA
| | - Martin R Bennett
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
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Raja A, Osborn EA, Bergmark BA, Croce KD, Poulin MF, Tamez H, West N, Buccola J, Meinen J, Secemsky EA. OCT utilization: Summary statistics from the LightLab clinical initiative. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S36-S43. [PMID: 36661366 DOI: 10.1002/ccd.30397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The study describes the evolution of optical coherence tomography (OCT) adoption and performance during percutaneous coronary intervention (PCI) following implementation of a standardized LightLab (LL) workflow. BACKGROUND The purpose of the LL Clinical Initiative was to evaluate the impact of a standardized workflow on physician efficiency, decision making, and image quality. METHODS The LL Clinical Initiative is a multicenter, prospective, observational clinical program. Data were collected from 48 physicians at 17 U.S. centers from 01/21/19 to 06/08/21. The study included 401 OCT-guided PCIs during the baseline phase and 1898 during the LL workflow phases. The baseline phase consisted of physicians utilizing OCT at their discretion. After completing the baseline phase, the workflow progressed through multiple phases culminating in the expansion phase, which focused on addressing greater procedural complexity. The LL workflow utilized OCT to assess plaque Morphology, lesion Length, and vessel Diameter before PCI, and optimized results by treating Medial edge dissection, stent mal-Apposition, and stent under-eXpansion (MLD MAX). High-level summary statistics were generated to elucidate trends. RESULTS After program implementation, there was a rise in the number of PCIs where the LL workflow was utilized compared to the baseline phase (68% during the expansion phase vs. 41% at baseline; p for trend <0.0001). Adoption of the LL workflow was associated with progressively greater procedural and lesion complexity when OCT was performed pre- and post-PCI (87% vs. 52%, p < 0.0001; 55% vs. 37%, p < 0.0001, respectively). In addition, the quality of OCT imaging obtained improved after LL workflow introduction, with over 95% of pre- and post-PCI pullback quality considered usable during the expansion phase. Finally, there was a reduction in time spent on OCT interpretation, both pre-PCI (4.6 min vs. 7.5 min, p < 0.0001) and post-PCI (2.9 min vs. 5.3 min, p < 0.0001). CONCLUSIONS After completion of the standardized OCT-guided workflow, there was greater uptake of OCT imaging, incorporation in more complex procedures, procedural efficiency, and image quality.
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Affiliation(s)
- Aishwarya Raja
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- NYP-Columbia, Columbia University, New York City, New York, USA
| | - Eric A Osborn
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brian A Bergmark
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin D Croce
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie-France Poulin
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hector Tamez
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nick West
- Abbott Vascular, Santa Clara, California, USA
| | | | | | - Eric A Secemsky
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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3
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Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indian Heart J 2020; 73:35-43. [PMID: 33714407 PMCID: PMC7961261 DOI: 10.1016/j.ihj.2020.12.008] [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: 09/08/2020] [Revised: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The no-reflow phenomenon occurs in 25% of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may be associated with adverse outcomes. The aim of our study was to detect novel predictors of no-reflow phenomenon and the resulting adverse long term outcomes. Methods We enrolled 400 STEMI patients undergoing primary PCI; 228 patients had TIMI flow 3 after PCI (57%) and the remaining 172 patients had TIMI flow <3 (43%). Fibrinogen to albumin ratio (FAR), high sensitive C-reactive protein to albumin ratio (CAR), and atherogenic index of plasma (AIP) were calculated. Long term mortality and morbidity during 6 months follow up were recorded. These data were compared among both groups. Results In multivariate regression analysis, old age (OR = 1.115, 95% CI: 1.032–1.205, P = 0.006), higher troponin level >5.6 ng/mL (OR = 1.040, 95% CI: 1.001–1.080, P = 0.04), diabetes mellitus (OR = 4.401, 95% CI: 1.081–17.923, P = 0.04) and heavy thrombus burden (OR = 16.915, 95% CI: 5.055–56.602, P < 0.001) could be considered as predictors for the development of no-reflow. Interestingly, CAR >0.21, FAR >11.56, and AIP >0.52 could be considered as novel powerful independent predictors (OR = 3.357, 95% CI: 2.288–4.927, P < 0.001, OR = 4.187, 95% CI: 2.761–6.349, P < 0.001, OR = 16.794, 95% CI: 1.018–277.01, P = 0.04, respectively). Higher long term mortality (P < 0.001) and heart failure (P < 0.001) was also strongly related to incidence of no-reflow. Conclusion No-reflow could be attributed to novel predictors as CAR, FAR, and AIP. This phenomenon was associated with long term adverse events as higher mortality and pump failure.
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Affiliation(s)
- Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt.
| | - Ayman Tantawy
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Amr S Gamal
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Hanan Radwan
- Cardiology Department, Zagazig University, Zagazig, Egypt
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4
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Refaat H, Tantawy A. Low Plasma Adiponectin Levels Are Associated With Vulnerable Plaque Features in Patients With Acute Coronary Syndrome: An Optical Coherence Tomography Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:63-71. [PMID: 33097459 DOI: 10.1016/j.carrev.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerable plaques are the primary cause of acute coronary syndrome (ACS). The association between in-vivo plaque vulnerability and adiponectin levels in ACS still remains to be determined. OBJECTIVE The purpose of this study was to investigate the correlation between adiponectin levels and vulnerable plaque features in ACS patients. METHODS We enrolled 107 ACS patients admitted to our institution; 83 with Non-ST elevation ACS (NSTE-ACS) and 24 with ST-elevation myocardial infarction (STEMI). Adiponectin levels were measured in these patients. Coronary angiography and subsequent optical coherence tomography (OCT) analysis of culprit lesions were performed. RESULTS Adiponectin level was lower in patients with complex angiographic lesions, compared to those with non-complex lesions (7.13 ± 3.04 vs. 8.94 ± 2.84 μg/ml, P = 0.002). Adiponectin level was lower in patients with plaque rupture (PR), micro-thrombi, and thin cap fibroatheroma (TCFA), compared to those with non-vulnerable features (7.19 ± 2.95 vs 8.79 ± 3.02 μg/ml, P = 0.007 & 7.29 ± 2.97 vs 8.44 ± 3.09 μg/ml, P = 0.04 and 4.76 ± 0.65 vs 9.74 ± 2.35 μg/ml, P < 0.001 μg/ml respectively). There was a significant negative correlation between adiponectin levels and lipid rich plaque extent and maximum lipid arc (r = -0.05, P < 0.001 & r = -0.03, P = 0.03, respectively). However, a significant positive correlation was observed between adiponectin levels and fibrous cap thickness (r = 0.95, P < 0.001). CONCLUSION Low adiponectin levels were associated with complex angiographic lesions and vulnerable plaque features in ACS patients, where there was a significant correlation between it and PR, TCFA, and lipid rich plaque.
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Affiliation(s)
- Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Ayman Tantawy
- Cardiology Department, Zagazig University, Zagazig, Egypt
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Optical Coherence Tomography Assessment of Morphological Characteristics in Suspected Coronary Artery Disease, but Angiographically Nonobstructive Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:475-479. [DOI: 10.1016/j.carrev.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
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6
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Zhang H, Wang G, Li Y, Lin F, Han Y, Wang H. Automatic Plaque Segmentation in Coronary Optical Coherence Tomography Images. INT J PATTERN RECOGN 2019. [DOI: 10.1142/s0218001419540351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary optical coherence tomography (OCT) is a new high-resolution intravascular imaging technology that clearly depicts coronary artery stenosis and plaque information. Study of coronary OCT images is of significance in the diagnosis of coronary atherosclerotic heart disease (CAD). We introduce a new method based on the convolutional neural network (CNN) and an improved random walk (RW) algorithm for the recognition and segmentation of calcified, lipid and fibrotic plaque in coronary OCT images. First, we design CNN with three different depths (2, 4 or 6 convolutional layers) to perform the automatic recognition and select the optimal CNN model. Then, we device an improved RW algorithm. According to the gray-level distribution characteristics of coronary OCT images, the weights of intensity and texture term in the weight function of RW algorithm are adjusted by an adaptive weight. Finally, we apply mathematical morphology in combination with two RWs to accurately segment the plaque area. Compared with the ground truth of clinical segmentation results, the Jaccard similarity coefficient (JSC) of calcified and lipid plaque segmentation results is 0.864, the average symmetric contour distance (ASCD) is 0.375[Formula: see text]mm, the JSC and ASCD reliabilities are 88.33% and 92.50% respectively. The JSC of fibrotic plaque is 0.876, the ASCD is 0.349[Formula: see text]mm, the JSC and ASCD reliabilities are 90.83% and 95.83% respectively. In addition, the average segmentation time (AST) does not exceed 5 s. Reliable and significantly improved results have been achieved in this study. Compared with the CNN, traditional RW algorithm and other methods. The proposed method has the advantages of fast segmentation, high accuracy and reliability, and holds promise as an aid to doctors in the diagnosis of CAD.
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Affiliation(s)
- Huaqi Zhang
- College of Electronic and Information Engineering, Hebei University, Baoding 071002, P. R. China
| | - Guanglei Wang
- College of Electronic and Information Engineering, Hebei University, Baoding 071002, P. R. China
| | - Yan Li
- College of Electronic and Information Engineering, Hebei University, Baoding 071002, P. R. China
| | - Feng Lin
- School of Computer Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yechen Han
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing 100005, P. R. China
| | - Hongrui Wang
- College of Electronic and Information Engineering, Hebei University, Baoding 071002, P. R. China
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7
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Amraotkar AR, Ghafghazi S, Trainor PJ, Hargis CW, Irfan AB, Rai SN, Bhatnagar A, DeFilippis AP. Presence of multiple coronary angiographic characteristics for the diagnosis of acute coronary thrombus. Cardiol J 2017; 24:25-34. [PMID: 28150291 DOI: 10.5603/cj.a2017.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/11/2017] [Accepted: 12/04/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronary angiography is frequently employed to aid in the diagnosis of acute coronary thrombosis, but there is limited data to support its efficacy. The aim of the study was to evaluate sensitivity and specificity of five commonly used angiographic characteristics for diagnosis of acute coronary thrombosis: Ambrose complex lesion morphology; spherical, ovoid, or irregular filling defect; abrupt vessel cutoff; intraluminal staining; and any coronary filling defect. METHODS Coronary angiography of 80 acute myocardial infarction or stable coronary artery disease subjects were assessed in blinded fashion, for the presence or absence of five angiographic characteristics. Only lesions of ≥ 10% stenosis were included in the analysis. Presence or absence of each angiographic characteristic was compared between lesions with or without the following study defined outcomes: 1) histologically confirmed thrombus, 2) highly probable thrombus, and 3) highly unlikely thrombus. RESULTS A total of 323 lesions were evaluated. All studied angiographic characteristics were associated with histologically confirmed and highly probable thrombotic lesions vs. lesions not meeting criteria for these outcomes (p < 0.03), except for complex Ambrose morphology which was not associated with any of the study outcomes (p > 0.05). Specificity for identifying histologically confirmed or highly probable thrombotic lesion was high (92-100%), especially for spherical, ovoid, or irregular filling defect (99-100%) and intraluminal staining (99%). Sensitivity for identification of histologically confirmed or highly probable thrombotic lesions was low for all tested angiographic characteristics (17-60%). CONCLUSIONS The presence of spherical, ovoid, or irregular filling defect or intraluminal staining was highly suggestive of coronary thrombus. However, none of the evaluated angiographic characteristics were useful for ruling out the presence of coronary thrombus. If confirmed in an independent cohort, these angiographic characteristic will be of significant value in confirming the diagnosis of acute coronary thrombosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States KentuckyOne Health, Jewish Hospital, Louisville, Kentucky, United States Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, United States.
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8
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Pasterkamp G, den Ruijter HM, Libby P. Temporal shifts in clinical presentation and underlying mechanisms of atherosclerotic disease. Nat Rev Cardiol 2016; 14:21-29. [DOI: 10.1038/nrcardio.2016.166] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2016; 32:697-709. [DOI: 10.1007/s10554-016-0877-1] [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: 10/21/2022]
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10
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Coronary optical coherence tomography: A practical overview of current clinical applications. Rev Port Cardiol 2016; 35:105-12. [DOI: 10.1016/j.repc.2015.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/13/2015] [Indexed: 01/01/2023] Open
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11
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Cruz Ferreira R, Pereira-da-Silva T, Patrício L, Bezerra H, Costa M. Coronary optical coherence tomography: A practical overview of current clinical applications. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Iannaccone M, Quadri G, Taha S, D'Ascenzo F, Montefusco A, Omede' P, Jang IK, Niccoli G, Souteyrand G, Yundai C, Toutouzas K, Benedetto S, Barbero U, Annone U, Lonni E, Imori Y, Biondi-Zoccai G, Templin C, Moretti C, Luscher TF, Gaita F. Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis. Eur Heart J Cardiovasc Imaging 2015; 17:1128-37. [PMID: 26508517 DOI: 10.1093/ehjci/jev283] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023] Open
MESH Headings
- Acute Coronary Syndrome/diagnostic imaging
- Acute Coronary Syndrome/mortality
- Acute Coronary Syndrome/therapy
- Aged
- Angina, Stable/diagnostic imaging
- Angina, Stable/mortality
- Angina, Stable/therapy
- Angina, Unstable/diagnostic imaging
- Angina, Unstable/mortality
- Angina, Unstable/therapy
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/epidemiology
- Coronary Artery Disease/pathology
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction/diagnostic imaging
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Plaque, Atherosclerotic/diagnostic imaging
- Plaque, Atherosclerotic/epidemiology
- Plaque, Atherosclerotic/pathology
- Predictive Value of Tests
- Prevalence
- Prognosis
- Risk Assessment
- Rupture, Spontaneous/diagnostic imaging
- Rupture, Spontaneous/epidemiology
- Survival Analysis
- Tomography, Optical Coherence/methods
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Affiliation(s)
- Mario Iannaccone
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Quadri
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Salma Taha
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Pierluigi Omede'
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Geraud Souteyrand
- Pole Cardiologie, Centre Hospitalier Universitaire de Clermont-Ferrant, Clermont-Ferrant, France
| | - Chen Yundai
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | | | - Sara Benedetto
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Umberto Barbero
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Umberto Annone
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Enrica Lonni
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Yoichi Imori
- Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan University Hospital, Zurich, Switzerland
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Claudio Moretti
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | | | - Fiorenzo Gaita
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
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