Advertisement

New prediction tools and treatment for ACS patients with plaque erosion

  • Rocco Vergallo
    Affiliations
    Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
    Search for articles by this author
  • Ik-Kyung Jang
    Correspondence
    Corresponding author. Cardiology Division, Massachusetts General Hospital, Harvard Medical School 55 Fruit Street | GRB 800, Boston, MA, 02114, USA.
    Affiliations
    Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Filippo Crea
    Affiliations
    Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Department of Cardiovascular and Pulmonary Sciences, Università Cattolica Sacro Cuore, Rome, Italy
    Search for articles by this author

      Highlights

      • Plaque erosion is responsible for more than one third of acute coronary syndromes (ACS) cases.
      • Patients with plaque erosion have a better prognosis than those with plaque rupture.
      • Plaque erosion may be stabilized by medical therapy without stent implantation.
      • Clinical, angiographic, and laboratory findings may aid plaque erosion's prediction.
      • Prediction of plaque erosion may allow to avoid unnecessary invasive procedures.

      Abstract

      For decades, we have known from autopsy observations that the proximate cause of the majority of acute coronary syndromes ( ACS) is occlusive thrombosis generated by plaque rupture or, less frequently, superficial erosion. Patients with ACS caused by plaque erosion seem to have a better long-term prognosis compared to those with plaque rupture, and may be stabilized by dual antiplatelet therapy without the need for stenting in a non-trivial proportion of cases, limiting the expenses and potential complications of invasive procedures. The accurate prediction of plaque erosion and the identification of specific biomarkers that could be used at the point-of-care without the need of invasive imaging would take us a step closer to the holy grail of precision medicine in patients with ACS.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Farb A.
        • Burke A.P.
        • Tang A.L.
        • et al.
        Coronary plaque erosion without rupture into a lipid core.
        A frequent cause of coronary thrombosis in sudden coronary death, Circulation. 1996; 93: 1354-1363
        • Arbustini E.
        • Dal Bello B.
        • Morbini P.
        • et al.
        Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction.
        Heart. 1999; 82: 269-272
        • Virmani R.
        • Kolodgie F.D.
        • Burke A.P.
        • et al.
        Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions.
        Arterioscler. Thromb. Vasc. Biol. 2000; 20: 1262-1275
        • Jia H.
        • Abtahian F.
        • Aguirre A.D.
        • et al.
        In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.
        J. Am. Coll. Cardiol. 2013; 62: 1748-1758
        • Vergallo R.
        • Ren X.
        • Yonetsu T.
        • et al.
        Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: a 3-vessel optical coherence tomography study.
        Am. Heart J. 2014; 167: 59-67
        • Sugiyama T.
        • Yamamoto E.
        • Bryniarski K.
        • et al.
        Nonculprit plaque characteristics in patients with acute coronary syndrome caused by plaque erosion vs plaque rupture: a 3-vessel optical coherence tomography study.
        JAMA Cardiol. 2018; 3: 207-214
        • Hu S.
        • Yonetsu T.
        • Jia H.
        • et al.
        Residual thrombus pattern in patients with ST-segment elevation myocardial infarction caused by plaque erosion versus plaque rupture after successful fibrinolysis: an optical coherence tomography study.
        J. Am. Coll. Cardiol. 2014; 63: 1336-1338
        • Pedicino D.
        • Vinci R.
        • Giglio A.F.
        • et al.
        Alterations of hyaluronan metabolism in acute coronary syndrome: implications for plaque erosion.
        J. Am. Coll. Cardiol. 2018; 72: 1490-1503
        • Niccoli G.
        • Montone R.A.
        • Di Vito L.
        • et al.
        Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome.
        Eur. Heart J. 2015; 36: 1377-1384
        • Ibanez B.
        • James S.
        • Agewall S.
        • et al.
        ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Rev Esp Cardiol (Engl Ed), 2017. 2017; 70: 1082
        • Roffi M.
        • Patrono C.
        • Collet J.P.
        • et al.
        ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC).
        Eur Heart J, 2016. 2015; 37: 267-315
        • Libby P.
        • Pasterkamp G.
        • Crea F.
        • et al.
        Reassessing the mechanisms of acute coronary syndromes.
        Circ. Res. 2019; 124: 150-160
        • Partida R.A.
        • Libby P.
        • Crea F.
        • et al.
        Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes.
        Eur. Heart J. 2018; 39: 2070-2076
        • Jia H.
        • Dai J.
        • Hou J.
        • et al.
        Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study).
        Eur. Heart J. 2017; 38: 792-800
        • Xing L.
        • Yamamoto E.
        • Sugiyama T.
        • et al.
        EROSION Study (Effective Anti-thrombotic Therapy without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion): A 1-Year Follow-Up Report.
        Circ Cardiovasc Interv, 2017: 10
        • Crea F.
        • Liuzzo G.
        Pathogenesis of acute coronary syndromes.
        J. Am. Coll. Cardiol. 2013; 61: 1-11
        • Libby P.
        Mechanisms of acute coronary syndromes and their implications for therapy.
        N. Engl. J. Med. 2013; 368: 2004-2013
        • Martinod K.
        • Wagner D.D.
        Thrombosis: tangled up in NETs.
        Blood. 2014; 123: 2768-2776
        • Badimon L.
        • Vilahur G.
        Neutrophil extracellular traps: a new source of tissue factor in atherothrombosis.
        Eur. Heart J. 2015; 36: 1364-1366
        • Quillard T.
        • Araujo H.A.
        • Franck G.
        • et al.
        TLR2 and neutrophils potentiate endothelial stress, apoptosis and detachment: implications for superficial erosion.
        Eur. Heart J. 2015; 36: 1394-1404
        • Franck G.
        • Mawson T.
        • Sausen G.
        • et al.
        Flow perturbation mediates neutrophil recruitment and potentiates endothelial injury via TLR2 in mice: implications for superficial erosion.
        Circ. Res. 2017; 121: 31-42
        • Doring Y.
        • Soehnlein O.
        • Weber C.
        Neutrophil extracellular traps in atherosclerosis and atherothrombosis.
        Circ. Res. 2017; 120: 736-743
        • van der Wal A.C.
        • Becker A.E.
        • van der Loos C.M.
        • et al.
        Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology.
        Circulation. 1994; 89: 36-44
        • Sugiyama S.
        • Kugiyama K.
        • Aikawa M.
        • et al.
        Hypochlorous acid, a macrophage product, induces endothelial apoptosis and tissue factor expression: involvement of myeloperoxidase-mediated oxidant in plaque erosion and thrombogenesis.
        Arterioscler. Thromb. Vasc. Biol. 2004; 24: 1309-1314
        • Ferrante G.
        • Nakano M.
        • Prati F.
        • et al.
        High levels of systemic myeloperoxidase are associated with coronary plaque erosion in patients with acute coronary syndromes: a clinicopathological study.
        Circulation. 2010; 122: 2505-2513
        • Niccoli G.
        • Montone R.A.
        • Cataneo L.
        • et al.
        Morphological-biohumoral correlations in acute coronary syndromes: pathogenetic implications.
        Int. J. Cardiol. 2014; 171: 463-466
        • Vergallo R.
        • Uemura S.
        • Soeda T.
        • et al.
        Prevalence and predictors of multiple coronary plaque ruptures: in vivo 3-vessel optical coherence tomography imaging study.
        Arterioscler. Thromb. Vasc. Biol. 2016; 36: 2229-2238
        • Vergallo R.
        • Porto I.
        • D'Amario D.
        • et al.
        Coronary atherosclerotic phenotype and plaque healing in patients with recurrent acute coronary syndromes compared with patients with long-term clinical stability: an in vivo optical coherence tomography study.
        JAMA Cardiol. 2019; 4: 321-329
        • Fracassi F.
        • Crea F.
        • Sugiyama T.
        • et al.
        Healed culprit plaques in patients with acute coronary syndromes.
        J. Am. Coll. Cardiol. 2019; 73: 2253-2263
        • Yonetsu T.
        • Suh W.
        • Abtahian F.
        • et al.
        Comparison of near-infrared spectroscopy and optical coherence tomography for detection of lipid.
        Cathet. Cardiovasc. Interv. 2014; 84: 710-717
        • Prati F.
        • Uemura S.
        • Souteyrand G.
        • et al.
        OCT-based diagnosis and management of STEMI associated with intact fibrous cap.
        JACC Cardiovasc. Imaging. 2013; 6: 283-287
        • Yahagi K.
        • Davis H.R.
        • Arbustini E.
        • et al.
        Sex differences in coronary artery disease: pathological observations.
        Atherosclerosis. 2015; 239: 260-267
        • Yamamoto E.
        • Yonetsu T.
        • Kakuta T.
        • et al.
        Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes.
        J. Am. Heart Assoc. 2019; 8e012322
        • Dai J.
        • Xing L.
        • Jia H.
        • et al.
        In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study.
        Eur. Heart J. 2018; 39: 2077-2085
        • Hayashi T.
        • Kiyoshima T.
        • Matsuura M.
        • et al.
        Plaque erosion in the culprit lesion is prone to develop a smaller myocardial infarction size compared with plaque rupture.
        Am. Heart J. 2005; 149: 284-290
        • Sun R.
        • Hu S.
        • Guagliumi G.
        • et al.
        Pre-infarction angina and culprit lesion morphologies in patients with a first ST-segment elevation acute myocardial infarction: insights from in vivo optical coherence tomography.
        EuroIntervention. 2019; 14: 1768-1775
        • Tian J.
        • Vergallo R.
        • Jia H.
        • et al.
        Morphologic characteristics of eroded coronary plaques: a combined angiographic, optical coherence tomography, and intravascular ultrasound study.
        Int. J. Cardiol. 2014; 176: e137-139
        • Vergallo R.
        • Porto I.
        • De Maria G.L.
        • et al.
        Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in patients with acute coronary syndrome: comparison with optical coherence tomography imaging.
        Int. J. Cardiol. 2019; 292: 25-31
        • Kim H.O.
        • Kim C.J.
        • Kurihara O.
        • et al.
        Angiographic features of patients with coronary plaque erosion.
        Int. J. Cardiol. 2019; 288: 12-16
        • Vergallo R.
        • Papafaklis M.I.
        • Yonetsu T.
        • et al.
        Endothelial shear stress and coronary plaque characteristics in humans: combined frequency-domain optical coherence tomography and computational fluid dynamics study.
        Circ. Cardiovasc. Imaging. 2014; 7: 905-911
        • Vergallo R.
        • Papafaklis M.I.
        • D'Amario D.
        • et al.
        Coronary plaque erosion developing in an area of high endothelial shear stress: insights from serial optical coherence tomography imaging.
        Coron. Artery Dis. 2019; 30: 74-75
        • Yamamoto E.
        • Thondapu V.
        • Poon E.
        • et al.
        Endothelial shear stress and plaque erosion: a computational fluid dynamics and optical coherence tomography study.
        JACC Cardiovasc. Imaging. 2019; 12: 374-375
        • Papaioannou T.G.
        • Stefanadis C.
        Vascular wall shear stress: basic principles and methods.
        Hellenic J. Cardiol. 2005; 46: 9-15
        • Chandran S.
        • Watkins J.
        • Abdul-Aziz A.
        • et al.
        Inflammatory differences in plaque erosion and rupture in patients with ST-segment elevation myocardial infarction.
        J. Am. Heart Assoc. 2017; 6
        • Soeda T.
        • Higuma T.
        • Abe N.
        • et al.
        Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture.
        Eur. Heart J. Cardiovasc. Imaging. 2017; 18: 103-110
        • Hu S.
        • Wang C.
        • Zhe C.
        • et al.
        Plaque erosion delays vascular healing after drug eluting stent implantation in patients with acute coronary syndrome: an in Vivo Optical Coherence Tomography Study.
        Cathet. Cardiovasc. Interv. 2017; 89: 592-600
        • Franck G.
        • Mawson T.L.
        • Folco E.J.
        • et al.
        Roles of PAD4 and NETosis in experimental atherosclerosis and arterial injury: implications for superficial erosion.
        Circ. Res. 2018; 123: 33-42
        • Soehnlein O.
        • Bazioti V.
        • Westerterp M.
        A pad 4 plaque erosion.
        Circ. Res. 2018; 123: 6-8
        • Shimokado A.
        • Matsuo Y.
        • Kubo T.
        • et al.
        In vivo optical coherence tomography imaging and histopathology of healed coronary plaques.
        Atherosclerosis. 2018; 275: 35-42
        • Vergallo R.
        • Crea F.
        Atherosclerotic plaque healing.
        N. Engl. J. Med. 2020; 383: 846-857

      Linked Article

      • New prediction tools for coronary plaque erosion: Don't forget computational fluid dynamic analysis
        AtherosclerosisVol. 323
        • Preview
          We read with great interest the review by Vergallo et al. regarding the novel prediction tools for plaque erosion in acute coronary syndrome [1]. As the author evidenced, the accurate and non-invasive prediction of plaque erosion still represents an unmet medical need in cardiovascular medicine. To this regard, among the available predictive tools, the authors in their elegant analysis did not report the promising results obtained over the last years using the computational fluid dynamic analysis (CFD) [2].
        • Full-Text
        • PDF