title: Morphology of exertion-triggered plaque rupture in patients with acute coronary syndrome: an optical coherence tomography study.
abstract: BACKGROUND
  Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men who experienced sudden death. The aim of the present study was to use optical coherence tomography to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient's activity at the onset of ACS.
  
  
  RESULTS
  The study population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent optical coherence tomography and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. The thickness of the broken fibrous cap correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% versus exertion 93%, P=0.014). The thickness of the broken fibrous cap in the exertion group was significantly higher than in the rest-onset group (rest onset: 50 microm [interquartile median 15 microm]; exertion: 90 microm [interquartile median 65 microm], P<0.01).
  
  
  CONCLUSIONS
  The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest and during the patient's day-to day activity, and some plaque rupture may occur in thick fibrous caps depending on exertion levels.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan. a-tanaka@wakayama-med.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Shigeho
authors.initials: S
authors.lastname: Takarada
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tsujioka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ikejima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ueno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kataiwa
authors.forename: Keishi
authors.initials: K
authors.lastname: Okouchi
authors.forename: Manabu
authors.initials: M
authors.lastname: Kashiwaghi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kazushi
authors.initials: K
authors.lastname: Takemoto
authors.forename: Nobuo
authors.initials: N
authors.lastname: Nakamura
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Masato
authors.initials: M
authors.lastname: Mizukoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology*; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D005082:Physical Exertion; D012146:Rest; D012421:Rupture / Q000209:etiology*