Layered plaques and coronary plaque vulnerability: an optical coherence tomography study

Abstract Background Layered plaques are a subclinical sign of plaque rupture or erosion, with plaque vulnerability and can be detected by optical coherence tomography (OCT). The study designed to evaluate the prevalence, angiographic, OCT characteristics of layered plaques in patients with acute coronary syndrome (ACS). Methods and results Consecutive ACS patients with 126 coronary culprit lesions underwent coronary angiography (CAG) and pre-intervention optical coherence tomography examination in this study. Patients were divided into layered plaque group (n = 57) and non-layered plaque group(n = 69) based on OCT plaque morphology. Layered plaque is heterogeneous signal-rich layered tissue of different optical signal intensity that close to the luminal surface, clearly demarcated from the underlying components on OCT. Patients with layered plaque were higher statin uptake rate compared to patients with non-layered plaque(P = 0.037). Uric acid (368.613 ± 91.840vs.327.901 ± 76.232µmol/L, P = 0.009) and Indirect bilirubin (IBil) (9.873 ± 5.252vs.8.130 ± 4.039, P = 0.037) level is higher in layered plaque group compare to patient with non-layered plaque. Longer lesion length in the layered plaque group compared with the non-layered plaque group (10(8,12) vs.8(5.5,10.0), P = 0.004). Higher lipid index (1400(631.5,2257) vs.1080(577.5,1455), P = 0.02)), Macrophage accumulation (49.1%vs.33.3%, P = 0.035) and TCFA (68.4%vs. 40.6%, P = 0.002) in the layered plaque group compared with the non-layered plaque group. Results of multivariate analyses showed that Uric acid was independent risk factors of layered plaque in our cohorts (P < 0.05). Conclusions This study demonstrate that layered plaques are associated with plaque vulnerability and progression of atherosclerosis at culprit lesions in patient with ACS.