Clinical features and lipid profiles of plaque erosion over lipid rich plaque versus fibrous plaque

Abstract

Abstract Backgrounds and aims Plaque erosion (PE) which is one of the most common causes of acute coronary syndrome (ACS) can occur over fibrous plaque or lipid-rich plaque (LRP) according to pathological reports. Whereas in plaque rupture (PR) the main cause of ACS, underlying plaque is basically LRP with thin fibrous cap. We aimed to investigate the clinical features and lipid profiles of PE with or without LRP in comparison to PR. Methods A total of 165 statin-naïve patients with ACS who underwent percutaneous coronary intervention using optical coherence tomography and met the criteria for PR or PE were included. LRP was defined as a plaque with lipid having the maximal lipid arc (>180°). Culprit lesions were categorized into the PR, PE with/without LRP [PE(LRP), PE(Fibrous), respectively). Results The prevalence of PR, PE(LRP), and PE(Fibrous) was 104 (63.0%), 42 (25.5%), and 19 (11.5%), respectively. Patients with PR and PE(LRP) had significantly higher peak creatine kinase (1338, 1733, 214 U/L, respectively, P<0.01) and more prevalence of ST-elevation myocardial infarction (71.2, 78.6, 21.1%, respectively, P<0.01) than PE(Fibrous). Overall, the levels of the various lipid profiles were mostly comparable between PE(Lipid) and PR but different in PE(Fibrous). The levels of small-dense low-density lipoprotein cholesterol was significantly greater in PR and PE(LRP) than in PE(Fibrous) (39.0, 36.6, 25.7 mg/dL, respectively, P=0.02). Conclusion PE(LRP) had substantially different clinical features and lipid profiles compared to PE(Fibrous) showing some similarity to those of PR. Funding Acknowledgement Type of funding sources: None.