Physicians' Academy for Cardiovascular Education

Identification of parameters associated with plaque erosion in STEMI and NSTE-ACS

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

Literature - Yamamoto E, Yonetsu T, Kakuta T, et al., - J Am Heart Assoc. 2019;8:e012322.

Introduction and methods

In about 25-40% of acute coronary syndromes (ACS), plaque erosion is reported to be responsible [1-3]. In all but low-risk subgroups, early invasive strategy is recommended [4,5], generally leading to implantation of coronary stents.

Recent studies suggest that ACS patients with plaque erosion may be treated conservatively without stenting [6-8]. Plaque erosion can be made visible by intracoronary optical coherence tomography (OCT). Demographic characteristics that may be specific for patients with plaque erosion, which may allow avoidance of invasive procedures, are unknown. This study therefore aimed to identify predictors for plaque erosion in patients with ACS.

This is a study in a new longitudinal international registry that included consecutive patients with ACS who had OCT imaging of the culprit lesion. ACS was considered as ST-segment-elevation myocardial infarction (STEMI), NSTE-ACS (including NSTEMI and unstable angina pectoris). 1241 Patients were included in the final cross-sectional analysis. Based on the OCT analysis, plaque type in the culprit lesion was categorized as:

Main results

The following predictors of plaque erosion were identified:

When all five predicting parameters are present in NSTE-ACS patients, probability of plaque erosion increased to 73.1%, with OR: 3.40 (95%CI: 1.39-8.29, P=0.007).


This international study in over 1200 patients with STEMI or NSTE-ACS, found that plaque erosion was more frequent in NSTE-ACS than in STEMI. Age <68 years, anterior ischemia, no diabetes, hemoglobin >15.0 g/dL and normal renal function were associated with plaque erosion. When all five aspects are present simultaneously, the probability of plaque erosion increases up to 73%. These data suggest that plaque erosion has a distinct pathobiology compared with plaque rupture. Use of the identified parameters needs to be evaluated in large-scale prospective clinical studies.


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