title: Prevalence and Predictors of Multiple Coronary Plaque Ruptures: In Vivo 3-Vessel Optical Coherence Tomography Imaging Study.
abstract: Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures.
  
  
  
  Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039).
  
  
  
  Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Cho
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ong
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Aguirre
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Biasucci
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.). ijang@mgh.harvard.edu yubodr@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
authors.forename: Chong-Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.). ijang@mgh.harvard.edu yubodr@163.com.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D009204:Myocardial Revascularization; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D041623:Tomography, Optical Coherence
keywords: atherosclerosis; fibroatheroma; incidence; optical coherence tomography; phenotype