Comparison Between Plaque Rupture and Plaque Erosion in the Setting of Acute Coronary Syndrome: Patient Characteristics and Procedural Outcomes

Document Type : Original Article


Cardiology Department, Ain Shams University, Cairo, Egypt.


Background: Acute coronary syndrome (ACS) caused by unstable plaque remains the leading cause of mortality and morbidity. The majority of acute coronary occlusion cases are attributed primarily to either plaque rupture or plaque erosion. This study aimed to investigate the effect of unstable plaque morphology on procedural outcomes among patients presenting with ACS.
Methods: This retrospective study enrolled 100 patients with ACS managed by optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in our tertiary center. The demographic and clinical characteristics, as well as angiographic and procedural data, of the study population were recorded. OCT was done before PCI and was repeated after PCI. The patients were thoroughly followed up for 180 days postprocedurally to detect 3 and 6 months’ adverse outcomes.
Results: The study population consisted of 100 patients. Men comprised 87% of the studied patients (mean age=53.3 y). Sixty-six patients had ST-segment-elevation myocardial infarction (STEMI), and the left anterior descending was the culprit vessel in 70% of the cases. Plaque rupture was more frequently associated with STEMI presentation, younger age, and white occlusive thrombi. Post-intervention OCT showed a mean minimum stent area of 8 mm2 and a mean stent expansion of 93.2%. No significant difference was observed between plaque erosion and plaque rupture regarding edge dissection and tissue protrusion. The no-reflow phenomenon was encountered solely among patients with plaque rupture.
Conclusions: OCT is safe and feasible in the setting of ACS. Stent malapposition could be easily missed in angiography. Plaque rupture was associated with more adverse angiographic outcomes in terms of the no-reflow phenomenon. (Iranian Heart Journal 2022; 23(2): 75-86)


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