Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome
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Determinants of ST‑segment elevation myocardial infarction as clinical presentation of acute coronary syndrome Osamu Kurihara1 · Masamichi Takano2 · Tsunekazu Kakuta3 · Tsunenari Soeda4 · Filippo Crea5 · Tom Adriaenssens6 · Holger M. Nef7 · Niklas F. Boeder7 · Erika Yamamoto1 · Hyung Oh Kim1 · Michele Russo1 · Iris McNulty1 · Makoto Araki1 · Akihiro Nakajima1 · Hang Lee8 · Kyoichi Mizuno9 · Ik ‑Kyung Jang1,10 Accepted: 11 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P
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