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Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes

BACKGROUND: Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti‐thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of pl...

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Autores principales: Yamamoto, Erika, Yonetsu, Taishi, Kakuta, Tsunekazu, Soeda, Tsunenari, Saito, Yoshihiko, Yan, Bryan P., Kurihara, Osamu, Takano, Masamichi, Niccoli, Giampaolo, Higuma, Takumi, Kimura, Shigeki, Minami, Yoshiyasu, Ako, Junya, Adriaenssens, Tom, Boeder, Niklas F., Nef, Holger M., Fracassi, Francesco, Sugiyama, Tomoyo, Lee, Hang, Crea, Filippo, Kimura, Takeshi, Fujimoto, James G., Fuster, Valentin, Jang, Ik‐Kyung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898801/
https://www.ncbi.nlm.nih.gov/pubmed/31640466
http://dx.doi.org/10.1161/JAHA.119.012322
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author Yamamoto, Erika
Yonetsu, Taishi
Kakuta, Tsunekazu
Soeda, Tsunenari
Saito, Yoshihiko
Yan, Bryan P.
Kurihara, Osamu
Takano, Masamichi
Niccoli, Giampaolo
Higuma, Takumi
Kimura, Shigeki
Minami, Yoshiyasu
Ako, Junya
Adriaenssens, Tom
Boeder, Niklas F.
Nef, Holger M.
Fracassi, Francesco
Sugiyama, Tomoyo
Lee, Hang
Crea, Filippo
Kimura, Takeshi
Fujimoto, James G.
Fuster, Valentin
Jang, Ik‐Kyung
author_facet Yamamoto, Erika
Yonetsu, Taishi
Kakuta, Tsunekazu
Soeda, Tsunenari
Saito, Yoshihiko
Yan, Bryan P.
Kurihara, Osamu
Takano, Masamichi
Niccoli, Giampaolo
Higuma, Takumi
Kimura, Shigeki
Minami, Yoshiyasu
Ako, Junya
Adriaenssens, Tom
Boeder, Niklas F.
Nef, Holger M.
Fracassi, Francesco
Sugiyama, Tomoyo
Lee, Hang
Crea, Filippo
Kimura, Takeshi
Fujimoto, James G.
Fuster, Valentin
Jang, Ik‐Kyung
author_sort Yamamoto, Erika
collection PubMed
description BACKGROUND: Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti‐thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. METHODS AND RESULTS: Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST‐segment elevation‐ACS than in ST‐segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age <68 years, anterior ischemia, no diabetes mellitus, hemoglobin >15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST‐segment elevation‐ACS, the probability of plaque erosion increased to 73.1%. CONCLUSIONS: Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of ACS patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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spelling pubmed-68988012019-12-16 Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes Yamamoto, Erika Yonetsu, Taishi Kakuta, Tsunekazu Soeda, Tsunenari Saito, Yoshihiko Yan, Bryan P. Kurihara, Osamu Takano, Masamichi Niccoli, Giampaolo Higuma, Takumi Kimura, Shigeki Minami, Yoshiyasu Ako, Junya Adriaenssens, Tom Boeder, Niklas F. Nef, Holger M. Fracassi, Francesco Sugiyama, Tomoyo Lee, Hang Crea, Filippo Kimura, Takeshi Fujimoto, James G. Fuster, Valentin Jang, Ik‐Kyung J Am Heart Assoc Original Research BACKGROUND: Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti‐thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. METHODS AND RESULTS: Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST‐segment elevation‐ACS than in ST‐segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age <68 years, anterior ischemia, no diabetes mellitus, hemoglobin >15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST‐segment elevation‐ACS, the probability of plaque erosion increased to 73.1%. CONCLUSIONS: Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of ACS patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03479723. John Wiley and Sons Inc. 2019-10-23 /pmc/articles/PMC6898801/ /pubmed/31640466 http://dx.doi.org/10.1161/JAHA.119.012322 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Yamamoto, Erika
Yonetsu, Taishi
Kakuta, Tsunekazu
Soeda, Tsunenari
Saito, Yoshihiko
Yan, Bryan P.
Kurihara, Osamu
Takano, Masamichi
Niccoli, Giampaolo
Higuma, Takumi
Kimura, Shigeki
Minami, Yoshiyasu
Ako, Junya
Adriaenssens, Tom
Boeder, Niklas F.
Nef, Holger M.
Fracassi, Francesco
Sugiyama, Tomoyo
Lee, Hang
Crea, Filippo
Kimura, Takeshi
Fujimoto, James G.
Fuster, Valentin
Jang, Ik‐Kyung
Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title_full Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title_fullStr Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title_full_unstemmed Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title_short Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes
title_sort clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898801/
https://www.ncbi.nlm.nih.gov/pubmed/31640466
http://dx.doi.org/10.1161/JAHA.119.012322
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