Mayuka Masuda, Takayoshi Toba, Yoichiro Sugizaki, Hiroyuki Kawamori, Takashi Hiromasa, Daichi Fujimoto, Tetsuya Yamamoto, Seigo Iwane, Hiroshi Tsunamoto, Shota Naniwa, Masayoshi Fujii, Yuki Sakamoto, Yuta Fukuishi, Koshi Matsuhama, Kotaro Higuchi, Hiroya Okamoto, Nobuhiro Watanabe, Ken Takata, Shotaro Yoshida, Masamichi Iwasaki, Amane Kozuki, Junya Shite, Tomofumi Takaya, Hiromasa Otake
RWSmaxwas independently associated with subsequent PR and PE, with a higher estimated probability of PR than of PE.
BACKGROUND: Radial wall strain (RWS) is a potential marker of plaque vulnerability; however, its association with plaque morphology in future acute coronary syndrome (ACS) remains unclear.
METHODS AND RESULTS: We retrospectively enrolled 98 patients with ACS who underwent optical coherence tomography-guided percutaneous coronary intervention and had a prior coronary angiography (CAG) 1 month to 5 years before ACS. RWS was calculated as the maximum percentage change in lumen diameter within a cardiac cycle (RWSmax). Mild-to-intermediate stenotic lesions on the index CAG were classified as culprit lesions (CLs) and non-CLs (NCLs) of ACS. CLs were further categorized as plaque rupture (PR) or erosion (PE). We identified 74 CLs (50 PRs, 24 PEs) and 96 NCLs. Angiographic and physiological parameters were comparable across the groups; however, RWSmaxwas significantly higher in both PRs and PEs than in NCLs (15.8% vs. 12.6%, P<0.001; 14.1% vs. 12.6%, P=0.012, respectively). In Cox regression analysis, RWSmaxwas associated with subsequent PRs (hazard ratio [HR] 1.56; 95% confidence interval [CI] 1.34-1.82; P<0.001) and PEs (HR 1.33; 95% CI 1.05-1.67; P=0.017). Multinomial logistic regression showed that higher RWSmaxfavored PR, lower RWSmaxfavored NCL, and the estimated probability of PE remained low across the RWSmaxspectrum.
CONCLUSIONS: RWSmaxwas independently associated with subsequent PR and PE, with a higher estimated probability of PR than of PE.