title: Thin-cap fibroatheroma as high-risk plaque for microvascular obstruction in patients with acute coronary syndrome.
abstract: BACKGROUND
  Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO after PCI in patients with ACS.
  
  
  RESULTS
  We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59), a nonrupture with TCFA group (n=21), and a nonrupture and non-TCFA group (n=35), according to optical coherence tomography findings of the culprit lesion. Using contrast-enhanced MRI, we assessed MVO. There were no statistically significant differences in patient characteristics. The nonrupture with TCFA group more frequently presented MVO (ruptured plaque, 27%; versus nonrupture with TCFA, 43%; versus non-TCFA and nonrupture, 9%; P=0.012). The prevalence of MVO increases as cap thickness decreases.
  
  
  CONCLUSIONS
  TCFA is more frequently associated with MVO after PCI. TCFA is a high-risk plaque for MVO after PCI in patients with ACS.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Manabu
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Shigeho
authors.initials: S
authors.lastname: Takarada
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komukai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Masato
authors.initials: M
authors.lastname: Mizukoshi
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis*; D011379:Prognosis; D018570:Risk Assessment; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome