Relationship between high shear stress and OCT-verified thin-cap fibroatheroma in patients with coronary artery disease

• Authors: Naotaka Okamoto, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Yuliya Vengrenyuk, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Valentin Fuster, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Habib Samady, Emory University; Keisuke Yasumura, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Usman Baber, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Nitin Barman, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Javed Suleman, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Joseph Sweeny, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Prakash Krishnan, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Roxana Mehran, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Samin K. Sharma, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Jagat Narula, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; Annapoorna S. Kini, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai
• Journal Title: PLOS ONE
• Volume: Volume 15, Number 12
• Publisher: PUBLIC LIBRARY SCIENCE | 2020-12-17, Pages e0244015-e0244015
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0244015
• Subjects: Health Sciences, Opthamology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; OPTICAL COHERENCE TOMOGRAPHY; INTRAVASCULAR ULTRASOUND; ATHEROSCLEROTIC PLAQUE; ANGIOGRAPHY; ACQUISITION; PROGRESSION; PREDICTION; STANDARDS; CONSENSUS; BURDEN

Abstract

High-risk coronary plaques have been considered predictive of adverse cardiac events. Both wall shear stress (WSS) in patients with hemodynamically significant lesions and optical coherence tomography (OCT) -verified thin-cap fibroatheroma (TCFA) are associated with plaque rupture, the most common underlying mechanism of acute coronary syndrome. The aim of the study was to test the hypothesis that invasive coronary angiography-based high WSS is associated with the presence of TCFA detected by OCT in obstructive lesions. From a prospective study of patients who underwent OCT examination for angiographically obstructive lesions (Yellow II), we selected patients who had two angiographic projections to create a 3-dimensional reconstruction model to allow assessment of WSS. The patients were divided into 2 groups according to the presence and absence of TCFA. Mean WSS was assessed in the whole lesion and in the proximal, middle and distal segments. Of 70 patients, TCFA was observed in 13 (19%) patients. WSS in the proximal segment (WSSproximal) (10.20 [5.01, 16.93Pa]) and the whole lesion (WSSlesion) (12.37 [6.36, 14.55Pa]) were significantly higher in lesions with TCFA compared to WSSproximal (5.84 [3.74, 8.29Pa], p = 0.02) and WSSlesion (6.95 [4.41, 11.60], p = 0.04) in lesions without TCFA. After multivariate analysis, WSSproximal was independently associated with the presence of TCFA (Odds ratio 1.105; 95%CI 1.007–1.213, p = 0.04). The optimal cutoff value of WSSproximal to predict TCFA was 6.79 Pa (AUC: 0.71; sensitivity: 0.77; specificity: 0.63 p = 0.02). Our results demonstrate that high WSS in the proximal segments of obstructive lesions is an independent predictor of OCT-verified TCFA.