Macrophage infiltrates in coronary plaque erosion and cardiovascular outcome in patients with acute coronary syndrome.

Montone, Rocco A, Vetrugno, Vincenzo, Camilli, Massimiliano, Russo, Michele, Fracassi, Francesco, Khan, Sohail Q, Doshi, Sagar N, Townend, Jonathan N, Ludman, Peter F, Trani, Carlo, Niccoli, Giampaolo and Crea, Filippo (2020) Macrophage infiltrates in coronary plaque erosion and cardiovascular outcome in patients with acute coronary syndrome. Atherosclerosis. ISSN 1879-1484.

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Official URL: http://www.journals.elsevier.com/atherosclerosis/

Abstract

BACKGROUND AND AIMS

Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS), and inflammation plays a key role in plaque instability. We assessed the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value.

METHODS

ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target-vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03-2.58) years].

RESULTS

We included 153 patients [median age (IQR) 64 (53-75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p = 0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression, PE with MØI was an independent predictor of MACEs [HR = 2.95, 95% CI (1.09-8.02), p = 0.034].

CONCLUSIONS

Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up.

Item Type: Article
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 29 Sep 2020 10:57
Last Modified: 29 Sep 2020 10:57
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3486

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