Clinical significance of healed plaque detected by optical coherence tomography: a 2-year follow-up study
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Clinical significance of healed plaque detected by optical coherence tomography: a 2‑year follow‑up study Osamu Kurihara1 · Michele Russo1 · Hyung Oh Kim1 · Makoto Araki1 · Hiroki Shinohara1 · Hang Lee2 · Masamichi Takano3 · Kyoichi Mizuno4 · Ik‑Kyung Jang1,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Recent studies have shown that healed plaque at the culprit lesion detected by optical coherence tomography (OCT) is a sign of pan-vascular vulnerability and advanced atherosclerosis. However, the clinical significance of healed plaque is unknown. A total of 265 patients who had OCT imaging of a culprit vessel and 2-year clinical follow-up data were included. Patients were stratified based on the presence or absence of a layered plaque phenotype, defined as layers of different optical density by OCT at either culprit or non-culprit lesions. The association between layered plaque and major adverse cardiac events (MACE), defined as cardiac death, acute coronary syndromes (ACS), or revascularization, was studied. Among 265 patients, 96 (36.2%) had the layered plaque phenotype. Layered plaque was more frequently observed in stable angina pectoris patients than in ACS patients (57.8%vs. 25.1%, p 50% on OCT [6] and at least 5 mm away from the stent edges.
Optical coherence tomography image acquisition and analysis
O. Kurihara et al.
plaques consisting of one or more layers with different optical density and a clear demarcation from underlying components [3, 5, 8]. Because layered plaque constitutes the morphologic counterpart of a healed plaque, the term ‘layered plaque’ and ‘healed plaque’ are used interchangeably in the present work. The presence of healed plaque was defined as detecting at least one layered plaque in the culprit vessel regardless of presence in the culprit or non-culprit lesion. OCT images were analyzed by an independent investigator who was blinded to clinical, angiographic, and laboratory data. Intra-observer coefficient Kappa index was evaluated after 2 weeks from the end of the analysis. Fifty randomly selected plaques were used to calculate intra- and interobserver coefficient Kappa indices about layered pattern, lipid pattern and macrophage infiltration. Intra-observer and inter-observer coefficient Kappa indices were respectively 0.84 and 0.76 for the layered pattern, 0.94 and 0.86 for lipid plaques, and 0.84 and 0.78 for macrophage infiltration. Representative OCT images of layered plaque, lipid rich plaque and macrophage infiltration were shown in Fig. 1.
Clinical follow‑up Clinical follow-up data was obtained from the MGH OCT Registry database. MACE, the end point of this study, was defined as cardiac death, ACS or revascularization. The decision to proceed with revascularization was left to the operator’s discretion.
Statistical analysis
The methods of OCT image acquisition and analysis have previously been described in detail [7], and summarized in the supplemental methods. Healed plaques were defined as
Categorical variables are presented as frequ
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