title: Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography.
abstract: BACKGROUND
  Pathological studies have suggested that acute coronary syndrome (ACS) may be caused by culprit lesions with intact fibrous cap (IFC), including plaque erosions. This study sought to evaluate the morphological features and clinical outcomes of patients with ACS caused by lesions with IFC.
  
  
  METHODS
  A total of 318 patients with ACS who underwent optical coherence tomography (OCT) of a culprit lesion were investigated. The culprit lesions were categorized as follows: those with plaque rupture (PR group), those with an IFC (IFC group), and those with a massive thrombus precluding plaque visualization (MT group). Intravascular ultrasound (IVUS) was performed in 297 patients. Clinical follow-up data were collected regarding adverse cardiac events, including death, myocardial infarction, revascularization, and congestive heart failure requiring hospitalization.
  
  
  RESULTS
  Culprit lesions were categorized into 141 RPs, 131 IFCs, and 46 MTs. IFC group exhibited a smaller remodeling index and less frequently attenuated plaques on IVUS. Three hundred and seven patients (96.5%) were followed for a median follow-up duration of 576 days. Adverse cardiac events were observed in 93 patients (30.3%). Kaplan-Meier analysis demonstrated a significantly lower event rate in IFC group compared with the RP and MT groups. Cox proportional hazard analysis demonstrated that an IFC and multivessel disease were independent predictors of adverse events [hazard ratio 0.57, 95% confidence interval (CI) 0.33-0.98, p=0.043 and hazard ratio 1.72, 95% CI 1.09-2.73, p=0.021].
  
  
  CONCLUSIONS
  Culprit lesions with IFC showed smaller remodeling indices by IVUS, and were associated with better long-term prognosis compared with those with plaque rupture.
authors.affiliation: Cardiology Department, Kameda Medical Center, Chiba, Japan. Electronic address: yonetsu@gmail.com.
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.affiliation: Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.affiliation: Cardiology Department, Kameda Medical Center, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Cardiology Department, Kameda Medical Center, Chiba, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: Cardiology Department, Kameda Medical Center, Chiba, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D012372:ROC Curve; D041623:Tomography, Optical Coherence / Q000379:methods*; D018084:Ultrasonography, Interventional
keywords: Acute coronary syndrome;; Optical coherence tomography;; Plaque erosion; Plaque rupture;