DOI: 10.1161/circ.148.suppl_1.16828 ISSN: 0009-7322

Abstract 16828: Plaque Rupture is Not Associated With Worse Clinical Outcomes in Contemporary Patients With Acute Coronary Syndrome

Kiyoshi Asakura, Yoshiyasu Minami, Takako Nagata, Masahiro Katamine, Yusuke Muramatsu, Daisuke Kinoshita, Kazuhiro Fujiyoshi, Junya Ako
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
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Introduction: The worse clinical outcomes in patients with plaque rupture (PR) than those with other pathogenesis of acute coronary syndrome (ACS) including plaque erosion and calcified plaque-related ACS have been reported.

Hypothesis: The incidence of recurrent adverse events in patients with PR is not higher than other ACS patients in the contemporary clinical setting of secondary prevention using high-intensity statin.

Methods: A total of 329 consecutive patients with ACS who underwent optical coherence tomography imaging of culprit lesions were included. Patients were classified into either the PR group (n = 133) or the non-PR group (n = 196). The incidence of major adverse cardiovascular events (MACE) at 1-year was compared between the two groups. MACE included cardiac death, non-fatal myocardial infarction, target vessel revascularization (TVR), and non-TVR.

Results: The prevalence of ST-elevation myocardial infarction (STEMI) as the initial clinical presentation was significantly higher in the PR group than in the non-PR group (58.6 vs. 42.3 %, p = 0.005). The prescription rate of high-intensity statin and/or ezetimibe at discharge was comparable in the two groups (84.2 vs. 84.7 %, p = 1.000). The incidence of MACE at 1-year was significantly lower in the PR group than in the non-PR group (log-rank p = 0.009) (Panel A). In the non-PR group, the levels of body mass index (26.5 ± 2.9 vs. 24.0 ± 3.9 kg/m 2 , p = 0.004) and hemoglobin A1c (7.2 ± 2.5 vs. 6.4 ± 1.2 %, p = 0.021) were significantly higher in patients with MACE than in those without (Panel B).

Conclusions: The incidence of MACE at 1-year in patients with PR was significantly lower than in those without PR in contemporary patients with ACS despite of the higher prevalence of baseline STEMI presentation. Further tailored optimization of secondary prevention against obesity and diabetes may be still required in ACS patients without PR.

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