Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis.
OBJECTIVE
The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined.


METHODS
All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs. nonST-elevation myocardial infarction (NSTEMI) vs. unstable angina (UA) vs. stable angina pectoris (SAP)].


RESULTS
One hundred and fifty citations were initially appraised at the abstract level and 23 full-text studies were assessed. The mean prevalence of CPR and TCFA was 48.1% (40.5-55.8) and 48.7% (37.4-60.1), respectively. The prevalence of CPR and TCFA were higher in STEMI (70.4 and 76.6%) than in NSTEMI (55.6 and 56.3%) and UA (39.1 and 52.9%) or SAP (6.2 and 22.8%). In the overall population at meta-regression analysis, TCFA and current smoking were the only predictors of CPR (B 3.6:2.0-5.1, P < 0.001 and 0.06:0.02-0.1, P = 0.002, respectively). The factors associated with CPR were different depending on clinical presentation. Hypertension was the only clinical predictor for STEMI (B 3.3: 1.2.-5.3 P = 0.001), while advanced age (B 0.12: 0.02-0.22, P = 0.021), diabetes mellitus (B 0.04: 0.01-0.08, P = 0.012), and hyperlipidaemia (B 0.07:0.02-0.11, P = 0.005) were the predictors in NSTEMI and UA. No clinical predictor was found in SA.


CONCLUSIONS
Our analysis showed high rates of CPR and TCFA detected by OCT in CAD patients, especially in those with ACS, although their prevalence is not negligible in stable patients. TCFA seems to be a strong predictor of CPR in all the ACS scenarios.
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy mario.iannaccone@hotmail.it.
Mario
M
Iannaccone
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Giorgio
G
Quadri
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Salma
S
Taha
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Fabrizio
F
D'Ascenzo
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Antonio
A
Montefusco
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Pierluigi
P
Omede'
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ik-Kyung
IK
Jang
Division of Cardiology, Cattolica del Sacro Cuore, Roma, Italy.
Giampaolo
G
Niccoli
Pole Cardiologie, Centre Hospitalier Universitaire de Clermont-Ferrant, Clermont-Ferrant, France.
Geraud
G
Souteyrand
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Chen
C
Yundai
Athens Medical School, Hippokration Hospital, Athens, Greece.
Konstantinos
K
Toutouzas
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Sara
S
Benedetto
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Umberto
U
Barbero
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Umberto
U
Annone
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Enrica
E
Lonni
Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan University Hospital, Zurich, Switzerland.
Yoichi
Y
Imori
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Giuseppe
G
Biondi-Zoccai
University Hospital, Zurich, Switzerland.
Christian
C
Templin
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Claudio
C
Moretti
University Hospital, Zurich, Switzerland.
Thomas F
TF
Luscher
Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
Fiorenzo
F
Gaita
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000453:epidemiology; D016019:Survival Analysis; D041623:Tomography, Optical Coherence / Q000379:methods*
Acute coronary syndrome; Optical coherence tomography; Plaque rupture; Thin cap