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In-vivo detection of the frequency and distribution of thin-cap fibroatheroma and ruptured plaques in patients with coronary artery disease: an optical coherence tomographic study

Rathore, Sudhir; Terashima, Mitsuyasu; Matsuo, Hitoshi; Kinoshita, Yoshihisa; Kimura, Masashi; Tsuchikane, Etsuo; Nasu, Kenya; Ehara, Mariko; Asakura, Yasushi; Katoh, Osamu; Suzuki, Takahiko

doi: 10.1097/MCA.0b013e32833e1c36
Diagnostic Methods

Objectives The purpose of this study was to assess the prevalence and to quantify the thin-cap fibroatheroma (TCFA) and ruptured plaques in patients with coronary artery disease using optical coherence tomography (OCT).

Background TCFA lesions are the most prevalent precursors of plaque rupture, and are responsible for acute coronary syndromes (ACS). There are limited data regarding the frequency and distribution of TCFA in diseased coronary arteries.

Methods Coronary artery OCT was performed in 78 vessels in 47 patients, with stable angina (SA) or ACS. OCT plaque characteristics were derived using criteria that had been validated earlier. TCFA was defined as rich in lipid (two or more quadrants) with thin fibrous cap (<65 μm). Comparison was made between SA and unstable angina, and culprit and nonculprit vessels.

Results There was a higher incidence of TCFA and plaque rupture (65 vs. 24%, P=0.003, and 40 vs. 15%, P=0.04) in ACS patients. This was reflected in a higher lipid pool (2.66 vs. 2.26 quadrants, P=0.04) and minimum fibrous cap thickness (52 vs. 74 μm, P=0.001) in ACS patients. The mean numbers of TCFA (2.5) were similar in patients with SA and ACS. However, the maximal length of TCFA (2.63 vs. 5.54 mm, P=0.026) and plaque rupture sites (P=0.046) were higher in ACS vessels. No relationship was found between baseline characteristics and TCFA incidence and plaque rupture. We identified ACS (P=0.002), higher mean lipid pool (P=0.002), longer TCFA length (P=0.007) and higher number of TCFA (P=0.02) as predictors of plaque rupture sites.

Conclusion In this in-vivo study, we identified a higher incidence of longer TCFAs and plaque rupture sites associated with ACS.

Department of Cardiology, Toyohashi Heart Center, Gobudori, Oyama-cho, Toyohashi, Japan

Correspondence to Dr Sudhir Rathore, MD, MRCP, Department of Cardiology, St George's Hospital NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK Tel: +44 7803 615142; fax: +44 2087 253178; e-mail:

None of the paper contents have been published before.

Received April 12, 2010

Accepted July 9, 2010

© 2011 Lippincott Williams & Wilkins, Inc.