title: Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study.
abstract: BACKGROUND
  Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied.
  
  
  RESULTS
  We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%,P<0.001), thrombus (59.4% versus 14.6%,P<0.001), and protrusion (93.8% versus 73.2%,P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1-year follow-up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events.
  
  
  CONCLUSIONS
  Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Yinchun
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jiannan
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Lulu
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Cardiology, University of Vermont College of Medicine/Fletcher Allen Healthcare, Burlington, VT.
authors.forename: Harold
authors.initials: H
authors.lastname: Dauerman
authors.affiliation: Nara Medical University, Nara, Japan.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Chunyang
authors.initials: C
authors.lastname: Zhe
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Gonghui
authors.initials: G
authors.lastname: Zheng
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Shaosong
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China jhb101180@163.com yubodr@163.com.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China jhb101180@163.com yubodr@163.com.|The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Kyung Hee University, Seoul, Korea.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
keywords: acute coronary syndrome; optical coherence tomography; plaque erosion; plaque rupture