title: Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: a 3-vessel optical coherence tomography study.
abstract: BACKGROUND
  Recent studies described different clinical and underlying plaque characteristics between patients with and without plaque rupture presenting with acute coronary syndrome (ACS). In light of the systemic nature of atherosclerosis, we hypothesized that nonculprit plaques might also express different morphological features in these 2 groups of patients.
  
  
  METHODS
  Thirty-eight patients with ACS who underwent 3-vessel optical coherence tomography imaging were identified from the Massachusetts General Hospital Optical Coherence Tomography Registry. Based on culprit plaque morphology, the study population was divided into 2 groups: patients with plaque rupture at the culprit lesion (group 1) and patients with nonruptured plaque at the culprit lesion (group 2). Prevalence and features of nonculprit plaques were compared between the 2 groups.
  
  
  RESULTS
  A total of 118 nonculprit plaques were analyzed. Patients in group 1 (n = 17) had nonculprit plaques with higher prevalence of thin-cap fibroatheroma (52.9% vs 19.0%, P = .029) and disruption (35.3% vs 4.8%, P = .016) compared with patients in group 2 (n = 21). Nonculprit plaques in group 1 showed wider maximum lipid arc (198.9° ± 41.7° vs 170.2° ± 41.9°, P = .003), greater lipid length (7.8 ± 4.4 mm vs 5.1 ± 2.4 mm, P = .003), higher lipid index (1196.9 ± 700.5 vs 747.7 ± 377.3, P = .001), and thinner fibrous cap (107.0 ± 56.5 μm vs 137.3 ± 69.8 μm, P = .035) compared with those in group 2.
  
  
  CONCLUSIONS
  The present study showed distinctive features of nonculprit plaques between patients with ACS caused by plaque rupture and patients with ACS caused by nonruptured plaques. Patients with plaque rupture had increased pancoronary vulnerability in nonculprit plaques, suggesting that a more aggressive treatment paradigm aiming at the stabilization of vulnerable plaques may offer additional benefit to these patients.
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Rocco
authors: R
authors: Vergallo
authors: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors: Xuefeng
authors: X
authors: Ren
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Taishi
authors: T
authors: Yonetsu
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Koji
authors: K
authors: Kato
authors: First Department of Medicine, Nara Medical University, Nara, Japan.
authors: Shiro
authors: S
authors: Uemura
authors: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors: Bo
authors: B
authors: Yu
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors: Haibo
authors: H
authors: Jia
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Farhad
authors: F
authors: Abtahian
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Aaron D
authors: AD
authors: Aguirre
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors: Jinwei
authors: J
authors: Tian
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors: Sining
authors: S
authors: Hu
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Tsunenari
authors: T
authors: Soeda
authors: Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Hang
authors: H
authors: Lee
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Iris
authors: I
authors: McNulty
authors: Asan Medical Center, Seoul, Republic of Korea.
authors: Seung-Jung
authors: SJ
authors: Park
authors: Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea.
authors: Yangsoo
authors: Y
authors: Jang
authors: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Abhiram
authors: A
authors: Prasad
authors: Department of Medicine, Queen Mary Hospital, Hong Kong University, Hong Kong, China.
authors: Stephen
authors: S
authors: Lee
authors: LightLab Imaging, Inc/St Jude Medical, Westford, MA.
authors: Shaosong
authors: S
authors: Zhang
authors: Cardiovascular and Neurological Department, San Donato Hospital, Arezzo Italy.
authors: Italo
authors: I
authors: Porto
authors: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors: Luigi M
authors: LM
authors: Biasucci
authors: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors: Filippo
authors: F
authors: Crea
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ijang@partners.org.
authors: Ik-Kyung
authors: IK
authors: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D012189:Retrospective Studies; D012421:Rupture; D041623:Tomography, Optical Coherence / Q000379:methods