Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients:an optical coherence tomography study

摘要

BACKGROUND Healed plaques are frequently found in patients with acute coronary syndrome,but the prognostic value is debatable.This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography(OCT)with the aim of predicting plaque progression of healed plaques.METHODS This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT ima-ging and follow-up angiography from January 2015 to December 2019.Plaque progression predictors were assessed by multivariate analysis.RESULTS Among 113 non-culprit lesions,27 healed plaques(23.9%)were identified.Patients with non-culprit healed plaques had prior antiplatelet therapy(65.0%vs.33.8%,P=0.019),hypertension(85.0%vs.50.7%,P=0.009),and dyslipidemia(70.0%vs.41.5%,P=0.04)which were more frequently than those without healed plaques.The thickness(r=0.674,P<0.001),arc(r=0.736,P<0.001),and volume(r=0.541,P=0.004)of healed plaque were correlated with minimum lumen diameter changes.At a mean follow-up of 11.5 months,the non-culprit healed plaques had a lower minimum lumen diameter(1.61±0.46 mm vs.1.91±0.73 mm,P=0.016),lower average lumen diameter(1.86 mm vs.2.10 mm,P=0.033),and a higher degree of diameter stenosis(41.4%±11.9%vs.35.5%±13.1%,P=0.031)when compared to baseline measurements.The plaque progression rate was higher in the healed plaque group(33.3%vs.8.1%,P=0.002),and multivariate analysis identified healed plaques[odds ratio(OR)=8.49,95%CI:1.71−42.13]and lumen thrombus(OR=10.69,95%CI:2.21−51.71)as predictors of subsequent lesion progression.CONCLUSIONS Healed plaques were a predictor for rapid plaque progression.The quantitative parameters of healed plaque showed a good agreement with plaque progression.Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol.Bifurcation lesions might be the predilection sites of healed plaques.