title: Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome.
abstract: OBJECTIVE
  Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS.
  
  
  RESULTS
  We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis was assessed according to such culprit lesion classification. Major adverse cardiac events (MACEs) were defined as the composite of cardiac death, non-fatal myocardial infarction, unstable angina, and target lesion revascularization (follow-up mean time 31.58 ± 4.69 months). The study comprised 139 consecutive ACS patients (mean age 64.3 ± 12.0 years, male 73.4%, 92 patients with non-ST elevation ACS and 47 with ST-elevation ACS). Plaque rupture was detected in 82/139 (59%) patients. There were no differences in clinical, angiographic, or procedural data between patients with PR when compared with those having IFC. Major adverse cardiac events occurred more frequently in patients with PR when compared with those having IFC (39.0 vs. 14.0%, P = 0.001). Plaque rupture was an independent predictor of outcome at multivariable analysis (odds ratio 3.735, confidence interval 1.358-9.735).
  
  
  CONCLUSIONS
  Patients with ACS presenting with PR as culprit lesion by OCT have a worse prognosis compared with that of patients with IFC. This finding should be taken into account in risk stratification and management of patients with ACS.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy gniccoli73@hotmail.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Montone
authors.affiliation: Department of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy C.L.I. Foundation, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Gramegna
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy Institute of Cardiology, Zagazig University, Zagazig, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Refaat
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Leone
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.affiliation: Department of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy C.L.I. Foundation, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000401:mortality / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000401:mortality / Q000473:pathology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Optical coherence tomography; Plaque rupture; Prognosis