Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry
Corresponding Author
Umberto Barbero MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Correspondence Umberto Barbero, MD, Cardiology Department, Città Della Salute e della Scienza Hospital, Turin, Italy. Email: [email protected]Search for more papers by this authorPaolo Scacciatella MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorMario Iannaccone MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorFabrizio D'Ascenzo MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorGiampaolo Niccoli MD
Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
Search for more papers by this authorFrancesco Colombo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorFabrizio Ugo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorSalvatore Colangelo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorMassimo Mancone MD
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorSimone Calcagno MD
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorGennaro Sardella MD, Prof
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorNicolas Amabile MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorPascal Motreff MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorKonstantinos Toutouzas MD
First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
Search for more papers by this authorRoberto Garbo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorCorrado Tamburino MD, Prof
Cardio-thoracic-vascular Department, Ferrarotto Hospital, University of Catania, Italy
Search for more papers by this authorAntonio Montefusco MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorPierluigi Omedè MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorClaudio Moretti MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorMaurizio D'amico MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorGeraud Souteyrand MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorFiorenzo Gaita MD, Prof
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorChristian Templin MD, Prof
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorCorresponding Author
Umberto Barbero MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Correspondence Umberto Barbero, MD, Cardiology Department, Città Della Salute e della Scienza Hospital, Turin, Italy. Email: [email protected]Search for more papers by this authorPaolo Scacciatella MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorMario Iannaccone MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorFabrizio D'Ascenzo MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorGiampaolo Niccoli MD
Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
Search for more papers by this authorFrancesco Colombo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorFabrizio Ugo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorSalvatore Colangelo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorMassimo Mancone MD
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorSimone Calcagno MD
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorGennaro Sardella MD, Prof
Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Italy
Search for more papers by this authorNicolas Amabile MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorPascal Motreff MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorKonstantinos Toutouzas MD
First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
Search for more papers by this authorRoberto Garbo MD
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy
Search for more papers by this authorCorrado Tamburino MD, Prof
Cardio-thoracic-vascular Department, Ferrarotto Hospital, University of Catania, Italy
Search for more papers by this authorAntonio Montefusco MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorPierluigi Omedè MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorClaudio Moretti MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorMaurizio D'amico MD
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorGeraud Souteyrand MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorFiorenzo Gaita MD, Prof
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy
Search for more papers by this authorChristian Templin MD, Prof
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorAbstract
Objectives
Culprit plaque characteristics in young patients who experience an Acute Coronary Syndrome (ACS) evaluated by OCT (Optical Coherence Tomography) have to be defined. The OCT-FORMIDABLE is a multicentre retrospective registry enrolling consecutive patients with ACS who performed OCT in 9 European centres.
Methods
Patients were divided in two groups according to age at presentation: juvenile-ACS (age ≤ 50 years) and not juvenile-ACS (age > 50 years). Primary end-point was the prevalence of plaque rupture (PR). Secondary end point was the prevalence of thin cap fibro atheroma (TCFA), fibrocalcific and fibrotic plaque.
Results
285 patients were included, 71 (24.9%) in juvenile-ACS group and 215 (75.1%) in not juvenile-ACS group. Younger patients showed a trend for a higher prevalence of TCFA (70 vs. 58%, P = 0.06) and thrombus presence (62 vs. 51%, P = 0.1), while no statistical difference concerning PR (70 vs. 64%, P = 0.29). Of interest patients younger that 35 years showed a higher prevalence of PR compared to patients aged between 35 and 45 or 45 and 50 years (100 vs. 72 vs. 55%, P = 0.03). Culprit plaque in juvenile-ACS group showed more frequently a reduced mean cap thickness (119 ± 66 vs. 155 ± 95 nm, P = 0.05) and less frequently fibrotic (32 vs. 57%, P < 0.001) or fibrocalcific (17 vs. 36%, P = 0.003) characteristics.
Conclusion
young patients with ACS show a trend for a higher prevalence of culprit PR, a thinner cap and less fibrotic or fibrocalcific components.
CONFLICTS OF INTEREST
The authors report no conflicts of interest regarding the content herein.
REFERENCES
- 1Jing M, Gao F, Chen Q, et al. Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction. Am J Cardiol, in press. doi: 10.1016/j.amjcard.2016.05.002.
10.1016/j.amjcard.2016.05.002 Google Scholar
- 2Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest 1995; 108: 364–369.
- 3Farmer JA, Gotto AM, Jr. Dyslipidemia and other risk factors for coronary artery disease. In: Braunwald E, editors. Heart Disease: A Text- book of Cardiovascular Medicine. Philadelphia: Saunders; 1997. pp 1126–1160.
- 4Meade TW, Mellows S, Brozovic M, et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986; 2: 533–537.
- 5Warren SE, Thompson SI, Vieweg WV. Historic and angiographic features of young adults surviving myocardial infarction. Chest 1979; 75: 667–670.
- 6Feng T, Yundai C, Lian C, et al. Assessment of coronary plaque characteristics by optical coherence tomography in patients with diabetes mellitus complicated with unstable angina pectoris. Atherosclerosis 2010; 213: 482–485.
- 7Rathore S, Terashima M, Matsuo H, et al. Association of coronary plaque composition and arterial remodelling: A optical coherence tomography study. Atherosclerosis 2012; 221: 405–415.
- 8Jang IK, Tearney GJ, MacNeill B, et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 2005; 111: 1551–1555.
- 9Iannaccone M, Quadri G, Taha S, et al. Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: A meta-analysis. Eur Heart J Cardiovasc Imaging, in press.
- 10D'Ascenzo F, Barbero U, Cerrato E, et al. Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: A meta-analysis of 2,581 patients and 2,807 lesions. Am Heart J 2015; 169: 663–673.
- 11Iannaccone M, D'Ascenzo F, Templin C, et al. Optical coherence tomography evaluation of intermediate-term healing of different stent types: Systemic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2017; 18: 159–166.
- 12Iannaccone M, D'Ascenzo F, Montefusco A. The butler did it! A very late stent thrombosis of TAXUS evaluated with Optical Coherence Tomography. Int J Cardiol 2015; 187: 141–143.
- 13Iannaccone M, D'Ascenzo F, Frangieh AH, et al. Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry. Catheter Cardiovasc Interv, 2016.
- 14Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999–3054.
- 15 American Diabetes Association. Standards of medical care for diabetes. Diabetes Care 2014; 37: S14–S80.
- 16Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: A report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59: 1058–1072.
- 17Ciruzzi M, Schargrodsky H, Rozlosnik J, et al. Frequency of family history of acute myocardial infarction in patients with acute myocardial infarction. Argentine FRICAS (Factores de Riesgo Coronario en America del Sur) Investigators. Am J Cardiol 1997; 80: 122–127.
- 18Ino Y, Kubo T, Tanaka A, et al. Difference of culprit lesion morphologies between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome: An optical coherence tomography study. JACC Cardiovasc Interv 2011; 4: 76–78.
- 19Virmani R, Burke AP, Farb A, et al. Pathology of the vulnerable plaque. J Am Coll Cardiol 2006; 47: C13–C18.
- 20Martí-Carvajal AJ, Solà I, Lathyris D, et al. Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev 2013; 31: 1.
- 21Gallagher PM, Meleady R, Shields DC, et al. Homocysteine and risk of premature coronary heart disease: Evidence for a common gene mutation. Circulation 1996; 94: 2154–2158.
- 22Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of highdensity lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341: 410–418.
- 23Meyer U, Schindler C, Bloesch T, et al. Combined impact of negative lifestyle factors on cardiovascular risk in children: a randomized prospective study. J Adolesc Health 2014; 55: 790–795.
- 24Colkesen AY, Acil T, Demircan S, et al. Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age. Coron Artery Dis 2008; 19: 345–347.
- 25Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999; 107: 254–261.
