Differential culprit plaque morphology in acute coronary syndrome: a comparison between very young patients (≤35 years) and older counterparts using optical coherence tomography

Gaurav Chaudhary; Basant Gupta; Shubhajeet Roy; Sharad Chandra; Akhil Sharma; Akshyaya Pradhan; Monika Bhandari; Pravesh Vishwakarma; Rishi Sethi; Sudhanshu Kumar Dwivedi; Vinit Baliyan; Prachi Sharma; Vikash Jaiswal; Abhishek Singh; Ayush Shukla; Sajina Shrestha; Alessia Gimelli

doi:10.1093/ehjimp/qyae046

Differential culprit plaque morphology in acute coronary syndrome: a comparison between very young patients (≤35 years) and older counterparts using optical coherence tomography

Eur Heart J Imaging Methods Pract. 2024 May 21;2(1):qyae046. doi: 10.1093/ehjimp/qyae046. eCollection 2024 Jan.

Authors

Gaurav Chaudhary¹, Basant Gupta¹, Shubhajeet Roy², Sharad Chandra¹, Akhil Sharma¹, Akshyaya Pradhan¹, Monika Bhandari¹, Pravesh Vishwakarma¹, Rishi Sethi¹, Sudhanshu Kumar Dwivedi¹, Vinit Baliyan³, Prachi Sharma¹, Vikash Jaiswal⁴, Abhishek Singh¹, Ayush Shukla¹, Sajina Shrestha⁵, Alessia Gimelli⁶

Affiliations

¹ Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
² King George Medical University, Lucknow, Uttar Pradesh, India.
³ Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
⁴ Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA.
⁵ Department of Medicine, KIST Medical College, Imadol, Patan, M86M+H4W, Mahalaxmi 44700, Nepal.
⁶ Department of Imaging, Fondazione Toscana 'Gabriele Monasterio', Pisa, Italy.

Abstract

Aims: Underlying mechanisms responsible for acute coronary syndrome (ACS) in young patients compared with older counterparts are yet to be explored with optical coherence tomography (OCT). This study aims to explore underlying mechanisms of ACS in ≤35- (very young) and >35-year-old (older counterparts) ACS patients using OCT.

Methods and results: This was a prospective, single-centre, investigational study. Patients were divided into groups according to age (≤35 and >35 years) and further subdivided according to the underlying mechanism i.e. plaque rupture (PR) and plaque erosion (PE). A total of 93 patients were analysed. Thin-cap fibroatheroma (TCFA) was significantly higher among older counterparts than very young patients for both PR (80.0% vs. 31.8%, P = 0.002) and PE (66.7% vs. 6.3%, P < 0.001) groups. Microchannels were also significantly more prevalent among older than very young patients for both PR (65.0% vs. 18.2%, P = 0.004) and PE groups (55.6% vs.12.5%, P = 0.013). Macrophages were significantly higher in older than very young patients for both PR (25.0% vs. 0%, P = 0.018) and PE (44.4% vs. 0%, P = 0.003) groups. In contrast, fibrous cap thickness was greater in very young than older patients for both PR (105.71 ± 48.02 vs. 58.00 ± 15.76 µm, P < 0.001) and PE (126.67 ± 48.22 vs. 54.38 ± 24.21 µm, P < 0.001) groups. Intimal thickness was greater in older than very young patients for both PR (728.00 ± 313.92 vs. 342.27 ± 142.02 µm, P < 0.001) and PE (672.78 ± 334.57 vs. 295.00 ± 99.60 µm, P < 0.001) groups.

Conclusion: Frequency of TCFA, microchannels, macrophages, and intimal thickness was significantly higher in older ACS patients compared with very young patients. However, fibrous cap thickness was significantly greater in very young ACS patients compared with older patients.

Keywords: acute coronary syndrome; intimal thickness; optical coherence tomography; plaque erosion; plaque rupture; thin-cap fibroatheroma.