title: Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome.
abstract: OBJECTIVE
  We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice.
  
  
  METHODS
  Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05.
  
  
  RESULTS
  A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29).
  
  
  CONCLUSIONS
  Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Jee Eun
authors.initials: JE
authors.lastname: Kwon
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Wang Soo
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Cardiovascular Research Foundation, New York, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Inje University Ilsan Paik Hospital, Koyang, Korea.
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Jeju National University Hospital, Jeju, Korea.
authors.forename: Ki Seok
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Samsung Medical Center, Seoul, Korea.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Kaup Sharath
authors.initials: KS
authors.lastname: Kumar
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Hoyoun
authors.initials: H
authors.lastname: Won
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Seong Hyeop
authors.initials: SH
authors.lastname: Hyeon
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Seung Yong
authors.initials: SY
authors.lastname: Shin
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Kwang Je
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Chee Jeong
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
keywords: Acute coronary syndrome; Atherosclerotic plaque; Optical coherence tomography