Original title: Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: A 3-vessel optical coherence tomography study. Reference: Rocco Vergallo et al. Am Heart J 2014;167:59-67.

Recent studies have described different clinical characteristics between ACS patients with and without ruptured culprit plaque. Given the systemic nature of atherosclerosis, the hypothesis of this study is that non culprit lesions would also express different characteristics than culprit lesions.

Based on culprit lesion characteristics, the population was divided in two groups: patients with ruptured plaque at the culprit lesion and patients with non ruptured plaque at the culprit lesion. Prevalence and characteristics of non culprit plaques were compared between these two groups of patients.

118 non culprit lesions were analyzed. Patients in the group with ruptured culprit lesion (n=17) presented non culprit plaque with higher prevalence of fibroatheroma with thin cap (52.9% vs 19.0%; p=0.029) or ruptured (35.3% vs 4.8%; p=0.016) compared to those patients whose culprit lesion was not ruptured (n=21).

In absolute values, the cap of non culprit lesions in the first group measured 107.0 ± 56.5 μm vs 137.3 ± 69.8 μm in the second group, a difference that turned out significative (p=0.035). All lipid content measurement parameters resulted higher in the non culprit plaque patients than in the group of ruptured culprit lesions.

Conclusion

The present study showed different characteristics of non culprit lesions by OCT between those patients presenting ACS caused by ruptured plaques and those whose culprit lesions were not ruptured.

Editorial Comment

This study has the limitation of being retrospective from the Massachusetts General Hospital OCT registry. The use of OCT in the 3 coronary vessels could have been limited by the context of ACS given the its clinically unstable nature and the difficulty to assess distal or ostial lesions. 

SOLACI