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Nelles G, Abdelwahed YS, Seppelt C, Meteva D, Stähli BE, Rai H, Seegers LM, Sieronski L, Musfeldt J, Gerhardt T, Riedel M, Skurk C, Haghikia A, Sinning D, Dreger H, Knebel F, Trippel TD, Krisper M, Klotsche J, Joner M, Landmesser U, Leistner DM. Cholesterol crystals at the culprit lesion in patients with acute coronary syndrome are associated with worse cardiovascular outcomes at two years follow up - results from the translational OPTICO-ACS study program. Int J Cardiol 2024; 399:131665. [PMID: 38141724 DOI: 10.1016/j.ijcard.2023.131665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Cholesterol crystals (CCs) represent a feature of advanced atherosclerotic plaque and may be assessed by optical coherence tomography (OCT). Their impact on cardiovascular outcomes in patients presenting with acute coronary syndromes (ACS) is yet unknown. METHODS The culprit lesion (CL) of 346 ACS-patients undergoing preintervention OCT imaging were screened for the presence of CCs and divided into two groups accordingly. The primary end-point was the rate of major adverse cardiac events plus (MACE+) consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to unstable or progressive angina at two years. RESULTS Among 346 patients, 57.2% presented with CCs at the CL. Patients with CCs exhibited a higher prevalence of ruptured fibrous caps (RFC-ACS) (79.8% vs. 56.8%; p < 0.001) and other high-risk features such as thin cap fibroatheroma (80.8% vs. 64.9%; p = 0.001), presence of macrophages (99.0% vs. 85.1%; p < 0.001) as well as a greater maximum lipid arc (294.0° vs. 259.3°; p < 0.001) at the CL as compared to patients without CCs. MACE+ at two years follow-up occurred more often in CC-patients (29.2% vs. 16.1%; p = 0.006) as compared to patients without CCs at the culprit site. Multivariable cox regression analysis identified CCs as independent predictor of MACE+ (HR 1.705; 1.025-2.838 CI, p = 0.040). CONCLUSIONS CCs were associated with conventional high-risk plaque features and associated with increased MACE+-rates at two years follow up. The identification of CCs might be useful as prognostic marker in patients with ACS and assist "precision prevention" in the future.
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Affiliation(s)
- Gregor Nelles
- Department of Cardiology, University Clinic Frankfurt, 60590 Frankfurt am Main, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany.
| | - Youssef S Abdelwahed
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Claudio Seppelt
- Department of Cardiology, University Clinic Frankfurt, 60590 Frankfurt am Main, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Denitsa Meteva
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Barbara E Stähli
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Himanshu Rai
- Department of Cardiology and ISAResearch Center, German Heart Center, 80636 Munich, Germany; Cardiovascular Research Institute (CVRI) Dublin at Mater Private Network Dublin, D07KWR1 Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, D02YN77 Dublin, Ireland
| | - Lena M Seegers
- Department of Cardiology, University Clinic Frankfurt, 60590 Frankfurt am Main, Germany
| | - Lara Sieronski
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Johanna Musfeldt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Teresa Gerhardt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin; Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Matthias Riedel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Carsten Skurk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Arash Haghikia
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
| | - David Sinning
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany
| | - Henryk Dreger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Fabian Knebel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Tobias D Trippel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximillian Krisper
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin, and Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Charité Mitte, 10117 Berlin
| | - Michael Joner
- Department of Cardiology and ISAResearch Center, German Heart Center, 80636 Munich, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Munich, 80636 Munich, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
| | - David M Leistner
- Department of Cardiology, University Clinic Frankfurt, 60590 Frankfurt am Main, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research) partner Site Berlin, 12203 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
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Abdelwahed YS, Nelles G, Frick C, Seppelt C, Meteva D, Stähli BE, Rai H, Riedel M, Skurk C, Rauch-Kröhnert U, Haghikia A, Sinning D, Dreger H, Knebel F, Trippel T, Krisper M, Klotsche J, Joner M, Landmesser U, Leistner DM. Coexistence of calcified- and lipid-containing plaque components and their association with incidental rupture points in acute coronary syndrome-causing culprit lesions: results from the prospective OPTICO-ACS study. Eur Heart J Cardiovasc Imaging 2021; 23:1598-1605. [PMID: 34904655 DOI: 10.1093/ehjci/jeab247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Rupture of the fibrous cap (RFC) represents the main pathophysiological mechanism causing acute coronary syndromes (ACS). Destabilization due to plaque biomechanics is considered to be importantly involved, exact mechanisms triggering plaque ruptures are, however, unknown. This study aims at characterizing the relation between plaque components and rupture points at ACS-causing culprit lesions in a large cohort of ACS-patients assessed by high-resolution intracoronary imaging. METHODS AND RESULTS Within the prospective, multicentric OPTICO-ACS study program, the ACS-causing culprit plaques of 282 consecutive patients were investigated following a standardized optical coherence tomography (OCT) imaging protocol. Each pullback was assessed on a frame-by-frame basis for the presence of lipid components (LC), calcium components (CC), and coexistence of both LC and CC (LCC) by two independent OCT-core labs. Of the 282 ACS-patients, 204 patients (72.3%) presented with ACS caused by culprit lesions with rupture of the fibrous cap (RFC-ACS) and 27.7% patients had ACS caused by culprit lesions with intact fibrous cap (IFC-ACS). When comparing RFC-ACS to IFC-ACS, a preferential occurrence of all three plaque components (LC, CC, and LCC) in RFC-ACS became apparent (P < 0.001). Within ruptured culprit lesions, the zone straight at the rupture point [extended rupture zone (RZ)] was characterized by similar (24.7% vs. 24.0%; P = ns) calcium content when compared with the proximal and distal border of the culprit lesion [border zone (BZ)]. The RZ displayed a significantly higher amount of both, LC (100% vs. 69.8%; P < 0.001) and LCC (22.7% vs. 6.8%; P < 0.001), when compared with the BZ. The relative component increase towards the RZ was particularly evident for LCC (+233.8%), while LC showed only a modest increase (+43.3%). CONCLUSIONS Calcified- and lipid-containing components characterize ruptured fibrous cap ACS-causing culprit lesions. Their coexistence is accelerated directly at the ruptured point, suggesting a pathophysiological contribution in the development of RFC-ACS.
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Affiliation(s)
- Youssef S Abdelwahed
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Gregor Nelles
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Clara Frick
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany
| | - Claudio Seppelt
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Denitsa Meteva
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Barbara E Stähli
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Himanshu Rai
- Department of Cardiology and ISAR Research Center, German Heart Center, 80636 Munich, Germany
| | - Matthias Riedel
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - David Sinning
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Campus Mitte (CCM), 10117 Berlin, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Campus Mitte (CCM), 10117 Berlin, Germany
| | - Tobias Trippel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Clinic (CVK), 13353 Berlin, Germany
| | - Maximillian Krisper
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Clinic (CVK), 13353 Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin, and Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Michael Joner
- Department of Cardiology, Charité University Medicine Berlin, Campus Mitte (CCM), 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Munch, 80636, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2 D-10178 Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203 Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2 D-10178 Berlin, Germany
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