Distinguishing patients before AMI based on plaque morphology

Patients with and without pre-infarction angina (PIA) could be distinguished based on culprit plaque morphology imaged by intracoronary optical coherence tomography (OCT). Patients with PIA displayed higher rates of intact fibrous cap (IFC) and plaque healing, and lower rates of thrombus burden. These results provide insights into the association between plaque morphology and the clinical presentation of acute myocardial infarction (AMI).

“It has been established that destabilisation in plaque morphology evolution is an important coronary thrombosis mechanism,” explained Dr Alfredo Ricchiuto (Università Cattolica del Sacro Cuore, Italy) [1]. “However, the association between culprit plaque morphology, healed culprit plaque prevalence, and the clinical presentation of AMI is mostly unexplored.” The current retrospective, observational study aimed to evaluate the differences in plaque morphology and healing capacity in patients with (n=50) and without PIA (n-52), who were assessed via intracoronary OCT.

Patients without PIA displayed higher rates of plaques rupture than patients with PIA (63.5% vs 42.0%) and lower rates of intact fibrous cap compared to patients with PIA (36.5% vs 58.0%). In addition, patients with PIA demonstrated higher rates of plaque rupture with macrophages (71.4%) than patients without PIA (27.3%). The thrombus burden was numerically lower in patients with PIA, although this result was not significant (P=0.145). Several plaque phenotypes (i.e. fibrous, lipid, thin cap fibroatheroma) did not show significant differences between patients with or without PIA. Furthermore, patients without PIA featured diffuse calcification more frequently (40.4%) than patients with PIA (22.0%). Finally, patients with PIA showed higher rates of healed plaques (66.0%) than patients without PIA (25.0%).

In conclusion, this study showed that patients with and without PIA have different plaque morphologies; thus, adding to the understanding of the clinical presentation of AMI and the underlying pathophysiological mechanisms.

 

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   1. Ricchiuto A, et al. Culprit plaque morphology and healing capacity in patients with and without pre-infarction angina: an optical coherence tomography imaging study. AC.AOS.483, AHA 2021 Scientific Sessions, 13–15 November.

 

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Posted on 14 January 2022