학술논문
Diagnosis and Prognostic Value of the Underlying Cause of Acute Coronary Syndrome in Optical Coherence Tomography-Guided Emergency Percutaneous Coronary Intervention.
Document Type
Academic Journal
Author
Kondo S; Division of Cardiology, Department of Medicine Showa University School of Medicine Tokyo Japan.; Mizukami T; Division of Clinical Pharmacology, Department of Pharmacology Showa University School of Medicine Tokyo Japan.; Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Tokyo Japan.; Kobayashi N; Department of Cardiology Nippon Medical School Chiba Hokusoh Hospital Chiba Japan.; Wakabayashi K; Division of Cardiology, Cardiovascular Center Showa University Koto-Toyosu Hospital Tokyo Japan.; Mori H; Division of Cardiology, Department of Internal Medicine Showa University Fujigaoka Hospital Yokohama Kanagawa Japan.; Yamamoto MH; Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Tokyo Japan.; Sambe T; Division of Clinical Pharmacology, Department of Pharmacology Showa University School of Medicine Tokyo Japan.; Yasuhara S; Division of Clinical Pharmacology, Department of Pharmacology Showa University School of Medicine Tokyo Japan.; Hibi K; Division of Cardiology Yokohama City University Medical Center Yokohama Kanagawa Japan.; Nanasato M; Department of Cardiology Sakakibara Heart Institute Tokyo Japan.; Sugiyama T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan.; Kakuta T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan.; Kondo T; Department of Medicine Hitachi Medical Center Hospital Ibaraki Japan.; Mitomo S; Department of Cardiovascular Medicine New Tokyo Hospital Chiba Japan.; Nakamura S; Department of Cardiovascular Medicine New Tokyo Hospital Chiba Japan.; Takano M; Department of Cardiology Nippon Medical School Chiba Hokusoh Hospital Chiba Japan.; Yonetsu T; Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan.; Ashikaga T; Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan.; Dohi T; Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan.; Yamamoto H; Division of Cardiology Teikyo University Hospital Tokyo Japan.; Kozuma K; Division of Cardiology Teikyo University Hospital Tokyo Japan.; Yamashita J; Department of Cardiology Tokyo Medical University Hospital Tokyo Japan.; Yamaguchi J; Department of Cardiology Tokyo Women's Medical University Tokyo Japan.; Ohira H; Department of Cardiology Edogawa Hospital Tokyo Japan.; Mitsumata K; Department of Cardiology Ayase Heart Hospital Tokyo Japan.; Namiki A; Department of Cardiology Kanto Rosai Hospital Kawasaki Kanagawa Japan.; Kimura S; Department of Cardiology Yokohama Minami Kyosai Hospital Yokohama Kanagawa Japan.; Honye J; Division of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa Japan.; Kotoku N; Division of Cardiology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Kanagawa Japan.; Higuma T; Division of Cardiology, Department of Internal Medicine Kawasaki Municipal Tama Hospital Kawasaki Kanagawa Japan.; Natsumeda M; Department of Cardiology Tokai University School of Medicine Kawasaki Kanagawa Japan.; Ikari Y; Department of Cardiology Tokai University School of Medicine Kawasaki Kanagawa Japan.; Sekimoto T; Division of Cardiology, Department of Internal Medicine Showa University Fujigaoka Hospital Yokohama Kanagawa Japan.; Matsumoto H; Division of Cardiology, Department of Medicine Showa University School of Medicine Tokyo Japan.; Suzuki H; Division of Cardiology, Department of Internal Medicine Showa University Fujigaoka Hospital Yokohama Kanagawa Japan.; Otake H; Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.; Sugizaki Y; Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.; Isomura N; Division of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa Japan.; Ochiai M; Division of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa Japan.; Suwa S; Department of Cardiovascular Medicine Juntendo University Shizuoka Hospital Shizuoka Japan.; Shinke T; Division of Cardiology, Department of Medicine Showa University School of Medicine Tokyo Japan.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
Subject
Language
English
Abstract
Background The prognostic impact of optical coherence tomography-diagnosed culprit lesion morphology in acute coronary syndrome (ACS) has not been systematically examined in real-world settings. Methods and Results This investigator-initiated, prospective, multicenter, observational study was conducted at 22 Japanese hospitals to identify the prevalence of underlying ACS causes (plaque rupture [PR], plaque erosion [PE], and calcified nodules [CN]) and their impact on clinical outcomes. Patients with ACS diagnosed within 24 hours of symptom onset undergoing emergency percutaneous coronary intervention were enrolled. Optical coherence tomography-guided percutaneous coronary intervention recipients were assessed for underlying ACS causes and followed up for major adverse cardiac events (cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization) at 1 year. Of 1702 patients with ACS, 702 (40.7%) underwent optical coherence tomography-guided percutaneous coronary intervention for analysis. PR, PE, and CN prevalence was 59.1%, 25.6%, and 4.0%, respectively. One-year major adverse cardiac events occurred most frequently in patients with CN (32.1%), followed by PR (12.4%) and PE (6.2%) (log-rank P <0.0001), primarily driven by increased cardiovascular death (CN, 25.0%; PR, 0.7%; PE, 1.1%; log-rank P <0.0001) and heart failure trend (CN, 7.1%; PR, 6.8%; PE, 2.2%; log-rank P <0.075). On multivariate Cox regression analysis, the underlying ACS cause was associated with 1-year major adverse cardiac events (CN [hazard ratio (HR), 4.49 [95% CI, 1.35-14.89], P =0.014]; PR (HR, 2.18 [95% CI, 1.05-4.53], P =0.036]; PE as reference). Conclusions Despite being the least common, CN was a clinically significant underlying ACS cause, associated with the highest future major adverse cardiac events risk, followed by PR and PE. Future studies should evaluate the possibility of ACS underlying cause-based optical coherence tomography-guided optimization.