Highlights
- •We explored the pancoronary plaque characteristics in ACS patients with cancer history by OCT.
- •The prevalence of cardiovascular risk factors and coronary artery disease in cancer patients is increased and is associated with higher mortality.
- •Cancer patients are excluded from ACS trials. The characteristics of coronary high-risk plaque of ACS and its evidence-based treatment are unknown.
- •ACS patients with cancer history have more high-risk plaque features in culprit and nonculprit lesions, compared with ACS patients without cancer history.
- •Our data provides important clinical value for the management and treatment of ACS patients with cancer history.
Abstract
Background and aims
The prevalence of acute coronary syndrome (ACS) patients with cancer history is increasing
and it is associated with higher mortality. However, there is limited evidence on
the characteristics of coronary plaque in ACS patients with cancer history. This study
explored the pancoronary plaque characteristics in ACS patients with cancer history
by optical coherence tomography (OCT).
Methods
A total of 306 ACS patients treated by 3-vessel OCT at the time of percutaneous coronary
intervention (PCI) were included, retrospectively. Patients were divided into two
groups according to the presence or absence of cancer history: one group with cancer
history (n = 98) and a matched group without cancer history (n = 208).
Results
A total of 314 culprit lesions and 514 nonculprit lesions were identified by OCT in
this study. In culprit lesions, ACS patients with cancer history had higher incidence
of thin cap fibroatheroma (TCFA) (p = 0.016), cholesterol crystals (p = 0.028), calcification (p = 0.001) and thrombus (p = 0.001), and had thinner fibrous cap thickness (FCT) (p = 0.011), greater maximum lipid arc (p = 0.042) and lipid index (p < 0.001), compared to matched ACS patients without cancer history. In nonculprit
lesions, ACS patients with cancer history had higher prevalence of high-risk plaque
(14.7% vs. 7.7%, p = 0.017), nonculprit rupture (14.7% vs. 6.3%, p = 0.003), and TCFA (52.2% vs. 28.3%, p < 0.001), and had higher incidence of calcification (p = 0.003), thrombus (p = 0.029), cholesterol crystals (p = 0.002) and microchannels (p = 0.029). These non-culprit lesions had longer lesion length (p = 0.001), thinner FCT (p < 0.001), greater maximum lipid arc (p = 0.016) and lipid index (p < 0.001).
Conclusions
ACS patients with cancer history showed more high-risk plaque features in culprit
and nonculprit lesions, compared with ACS patients without cancer history. Therefore,
ACS patients with cancer history may have greater pancoronary vulnerability. This
may predict a poorer prognosis for ACS patients with cancer history.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 19, 2023
Accepted:
March 31,
2023
Received in revised form:
March 13,
2023
Received:
December 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier B.V.
