Coronary microevaginations characterize culprit plaques and their inflammatory microenvironment in a subtype of acute coronary syndrome with intact fibrous cap: results from the prospective translational OPTICO-ACS study.

Autor:	Seppelt C; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Abdelwahed YS; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Meteva D; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Nelles G; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany., Stähli BE; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany., Erbay A; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Kränkel N; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Sieronski L; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Skurk C; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany., Haghikia A; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Berlin Institute of Health (BIH), 10117 Berlin, Germany., Sinning D; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany., Dreger H; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany., Knebel F; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Department of Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany., Trippel TD; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany., Krisper M; Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany., Gerhardt T; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Berlin Institute of Health (BIH), 10117 Berlin, Germany., Rai H; Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany.; Cardiovascular Research Institute Dublin, Imaging Core Lab, Mater Private Network, Dublin D07 YH66, Ireland.; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin D02 YN77, Ireland., Klotsche J; German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Charité Mitte, Berlin 10117, Germany., Joner M; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany., Landmesser U; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Berlin Institute of Health (BIH), 10117 Berlin, Germany., Leistner DM; Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.; Berlin Institute of Health (BIH), 10117 Berlin, Germany.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2024 Jan 29; Vol. 25 (2), pp. 175-184.
DOI:	10.1093/ehjci/jead154
Abstrakt:	Aims: Coronary microevaginations (CMEs) represent an outward bulge of coronary plaques and have been introduced as a sign of adverse vascular remodelling following coronary device implantation. However, their role in atherosclerosis and plaque destabilization in the absence of coronary intervention is unknown. This study aimed to investigate CME as a novel feature of plaque vulnerability and to characterize its associated inflammatory cell-vessel-wall interactions. Methods and Results: A total of 557 patients from the translational OPTICO-ACS study programme underwent optical coherence tomography imaging of the culprit vessel and simultaneous immunophenotyping of the culprit lesion (CL). Two hundred and fifty-eight CLs had a ruptured fibrous cap (RFC) and one hundred had intact fibrous cap (IFC) acute coronary syndrome (ACS) as an underlying pathophysiology. CMEs were significantly more frequent in CL when compared with non-CL (25 vs. 4%, P < 0.001) and were more frequently observed in lesions with IFC-ACS when compared with RFC-ACS (55.0 vs. 12.7%, P < 0.001). CMEs were particularly prevalent in IFC-ACS-causing CLs independent of a coronary bifurcation (IFC-ICB) when compared with IFC-ACS with an association to a coronary bifurcation (IFC-ACB, 65.4 vs. 43.7%, P = 0.030). CME emerged as the strongest independent predictor of IFC-ICB (relative risk 3.36, 95% confidence interval 1.67-6.76, P = 0.001) by multivariable regression analysis. IFC-ICB demonstrated an enrichment of monocytes in both culprit blood analysis (culprit ratio: 1.1 ± 0.2 vs. 0.9 ± 0.2, P = 0.048) and aspirated culprit thrombi (326 ± 162 vs. 96 ± 87 cells/mm2, P = 0.017), while IFC-ACB confirmed the accumulation of CD4+ T cells, as recently described. Conclusion: This study provides novel evidence for a pathophysiological involvement of CME in the development of IFC-ACS and provides first evidence for a distinct pathophysiological pathway for IFC-ICB, driven by CME-derived flow disturbances and inflammatory activation involving the innate immune system. Trial Registration: Registration of the study at clinicalTrials.gov (NCT03129503). Competing Interests: Conflict of interest: D.M.L. received lecture honoraria from Amgen, Abbott Vascular, AstraZeneca, and Novo Nordisk. M.J. received consulting fees from Biotronik, TriCares, Veryan, and Shockwave, and is in the Steering Committee of Biotronik and Edwards Lifesciences. T.D.T. received payment honoraria from Novartis, AstraZeneca, Berlin Chemie, Abbott, NeoVasc, and Amgen. U.L. reports lecture and advisory honorary from Abbott. All other authors report no conflicts of interest. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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