title: Association between cholesterol crystals and culprit lesion vulnerability in patients with acute coronary syndrome: An optical coherence tomography study.
abstract: BACKGROUND
  Cholesterol Crystals (ChCs) are recognized as a hallmark of advanced atherosclerotic lesions. Previous animal and histopathology studies have revealed that Cholesterol crystallization trigger a local inflammatory response and plaque rupture. We sought to investigate the in vivo relationship between ChCs and culprit lesion vulnerability in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  206 culprit lesions from 206 patients with ACS who underwent optical coherence tomography (OCT) imaging were divided into 2 groups based on the presence or absence of ChCs. Culprit lesions characteristics were compared between ChCs and Non-ChCs groups.
  
  
  RESULTS
  For overall ACS patients, culprit lesions with ChCs had higher incidence of macrophages accumulation (77.8% vs. 40.0%, p < 0.001), microchannel (67.9% vs. 24.8%, p < 0.001), plaque rupture (58.0% vs. 36.0%, p = 0.001), thrombosis (66.7% vs. 49.6%, p = 0.016) and spotty calcification (35.8% vs. 10.4%, p < 0.001). In addition, the mean lipid arc (274.2 ± 57.6° vs. 228.1 ± 66.3°, p < 0.001) was larger and the lipid index (3826.1 ± 2111.4 vs. 2855.0 ± 1753.0, p = 0.001) was greater. The frequency of ChCs was significantly higher in patients with STEMI, as compared with NSTEACS (50.8% vs. 34.7%, p = 0.032). Larger lipid arc, higher incidence of macrophages accumulation and that of microchannel were observed in culprit lesions with ChCs in both STEMI (p = 0.028, p < 0.001, and p = 0.002 respectively) and NSTEACS (p < 0.001, p < 0.001, and p < 0.001 respectively) subgroups.
  
  
  CONCLUSIONS
  ChCs were frequently associated with characteristics of vulnerable plaques in ACS culprit lesions as well as in STEMI and NSTEACS subgroups. ChCs and vulnerable plaque features were more often observed in culprit lesions of STEMI patients compared to NSTEACS patients.
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Jiannan
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: tianjinweidr2009@163.com.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Tian
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Shengliang
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Lijia
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Huai
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Ren
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Nana
authors.initials: N
authors.lastname: Dong
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000378:metabolism*; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002784:Cholesterol / Q000032:analysis*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D003331:Coronary Vessels / Q000737:chemistry* / Q000000981:diagnostic imaging*; D003460:Crystallization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000378:metabolism; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence
chemical_list: D015415:Biomarkers; D002784:Cholesterol
keywords: Acute coronary syndrome; Atherosclerosis; Cholesterol crystals; Optical coherence tomography