Author + information
- Received September 4, 2019
- Revision received January 6, 2020
- Accepted January 9, 2020
- Published online September 7, 2020.
- Makoto Araki, MD, PhDa,
- Tsunenari Soeda, MD, PhDb,∗∗ (, )
- Hyung Oh Kim, MD, PhDa,
- Vikas Thondapu, MD, PhDa,
- Michele Russo, MDa,
- Osamu Kurihara, MD, PhDa,
- Hiroki Shinohara, MDa,
- Yoshiyasu Minami, MD, PhDc,
- Takumi Higuma, MD, PhDd,
- Hang Lee, PhDe,
- Taishi Yonetsu, MDf,
- Tsunekazu Kakuta, MD, PhDg and
- Ik-Kyung Jang, MD, PhDa,h,∗ ()
- aCardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- cDepartment of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- dDivision of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
- eBiostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- fDepartment of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
- gDepartment of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
- hDivision of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
- ↵∗Address for correspondence:
Dr. Ik-Kyung Jang, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, Massachusetts 02114.
- ↵∗∗Dr. Tsunenari Soeda, Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Objectives The authors performed a comprehensive analysis on the distribution of coronary plaques with different phenotypes from our 3-vessel optical coherence tomography (OCT) database.
Background Previous pathology studies demonstrated that thin-cap fibroatheroma (TCFA) is localized in specific segments of the epicardial coronary arteries. A detailed description of in vivo coronary plaques of various phenotypes has not been reported.
Methods OCT images of all 3 coronary arteries in 131 patients were analyzed every 1 mm to assess plaque phenotype and features of vulnerability. In addition, plaques were divided into tertiles according to percent area stenosis (%AS).
Results Among 534 plaques identified in 393 coronary arteries, 27.0% were fibrous plaques, 13.3% were fibrocalcific plaques, 40.8% were thick-cap fibroatheromas, and 18.9% were TCFAs. TCFAs showed clustering in the proximal segment, particularly in the left anterior descending artery. On the other hand, fibrous plaques were relatively evenly distributed throughout the entire length of the coronary arteries. In patients with acute coronary syndromes (ACS), TCFAs showed stronger proximal clustering in the left anterior descending, 2 clustering peaks in the right coronary artery, and 1 clustering peak in the circumflex artery. The pattern of TCFA distribution was less obvious in patients without ACS. The prevalence of TCFA was higher in the highest %AS tertile, compared with the lowest %AS tertile (30% vs. 9%; p < 0.001).
Conclusions The present 3-vessel OCT study showed that TCFAs cluster at specific locations in the epicardial coronary arteries, especially in patients with ACS. TCFA was more prevalent in segments with tight stenosis. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538)
Dr. Jang has received educational grants from Abbott Vascular; they had no role in the design or conduct of this research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received September 4, 2019.
- Revision received January 6, 2020.
- Accepted January 9, 2020.
- 2020 American College of Cardiology Foundation
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