Atherosclerotic Coronary Plaque Features in Patients With Chronic Obstructive Pulmonary Disease and Acute Coronary Syndrome

Abstract

Previous studies reported a robust relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). Systemic inflammation has been proposed as possible pathogenetic mechanism linking these two entities, although data on atherosclerotic coronary features in COPD patients are lacking. We studied atherosclerotic coronary plaque features in COPD patients presenting with acute coronary syndromes (ACS) by using optical coherence tomography (OCT). ACS patients undergoing intracoronary OCT imaging of the culprit vessel were enrolled. Coronary plaque characteristics and OCT-defined macrophage infiltration (MØI) were assessed by OCT. ACS patients were divided into two groups according to the presence of an established diagnosis of COPD, and plaque features at the culprit site and along the culprit vessel were compared between the groups. Among 146 ACS patients (mean age:66.1±12.7 years, 109 males), 47 (32.2%) had COPD. Patients with COPD had significantly higher prevalence of MØI (78.7% vs. 54.5%, p=0.005) and thin cap fibroatheroma (TCFA) (48.9% vs. 22.2%, p=0.001) at the culprit site. In the multivariate logistic regression, COPD was independently associated with MØI (OR:21.209, CI95%:1.679;267.910, p=0.018) and TCFA at the culprit site (OR:5.345, CI95%:1.386;20.616, p=0.015). Similarly, COPD was independently associated with both MØI (OR:3.570, CI95%:1.472;8.658, p=0.005) and TCFA (OR:4.088, CI95%:1.584;10.554, p=0.004) along the culprit vessel. In conclusion, in ACS patients undergoing OCT imaging of the culprit vessel, COPD was an independent predictor of plaque inflammation and vulnerability. These results may suggest that a higher inflammatory milieu in COPD patients might enhance local coronary inflammation, promoting CAD development and plaque vulnerability.