Vergallo R, et al. - In patients at the ends of the coronary artery disease (CAD) spectrum, the coronary atherosclerotic phenotype and the prevalence and features of healed coronary plaques was evaluated by optical coherence tomography (OCT) imaging. Differences were found in the atherosclerotic phenotype in patients with recurrent acute coronary syndromes (rACS) vs those with long-standing stable angina pectoris (ls-SAP). There was a higher prevalence of thin-cap fibroatheroma and lower prevalence of healed coronary plaques seen in rACS patients. This was suggestive of a role played by atherosclerotic profile and plaque healing in leading the natural history of patients with CAD.

Methods

• In this observational, single-center cohort study, prospective clinical follow-up data were analyzed for 105 of 823 consecutive patients enrolled in OCT Registry of the Fondazione Policlinico A. Gemelli–IRCCS, Rome, Italy, from March 2009 to February 2016.
• Participants were categorized as those with rACS, defined as history of at least 3 acute myocardial infarctions (AMIs) or at least 4 ACS with at least 1 AMI; those with long-standing stable angina pectoris (ls-SAP), defined as a minimum 3-year history of stable angina; and those with a single unheralded AMI followed by a minimum 3-year period of clinical stability (sAMI).
• Data analysis was carried out from January to August 2018.
• In nonculprit segments evaluated by intracoronary OCT imaging, coronary plaque features and the prevalence of healed coronary plaques were determined.

Results

• With median (interquartile range) age of 68 (63-75) years, 105 patients were included, among whom, 85 were men (81.0%).
• In the ls-SAP group and in the sAMI group, the median (interquartile range) time of clinical stability was 9 (5.0-15.0) years and 8 (4.5-14.5) years, respectively.
• Similar prevalence of lipid-rich plaque and thin-cap fibroatheroma was seen among patients in the rACS and sAMI groups, whereas, it was significantly higher as compared with those with ls-SAP (lipid-rich plaque 80.0% [n = 24 of 30] vs 76.3% [n = 29 of 38] vs 37.8% [n = 14 of 37], respectively; P < .001; thin-cap fibroatheroma 40.0% [n = 12 of 30] vs 34.2% [n = 13 of 38] vs 8.1% [n = 3 of 37], respectively; P = .006).
• Patients with rACS vs those with ls-SAP and sAMI demonstrated spotty calcifications more frequently (70.0% [n = 21 of 30] vs 40.5% [n = 15 of 37] vs 44.7% [n = 17 of 38], respectively; P = .04).
• A rare prevalence of healed coronary plaques was found in patients with rACS, whereas patients with ls-SAP and sAMI had a significantly higher prevalence of healed coronary plaques (3.3% [n = 1 of 30] vs 29.7% [n = 11 of 37] vs 28.9% [n = 11 of 38], respectively; P = .01).