ISSN 2149-2263 | E-ISSN 2149-2271
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Culprit lesion characteristics in very young patients with acute coronary syndrome: An optical coherence tomography study [Anatol J Cardiol]
Anatol J Cardiol. 2021; 25(10): 684-690 | DOI: 10.5152/AnatolJCardiol.2021.58084

Culprit lesion characteristics in very young patients with acute coronary syndrome: An optical coherence tomography study

Sharad Chandra, Snigdha Boddu, Gaurav Chaudhary, Akhil Sharma, Akshyaya Pradhan, Monika Bhandari, Pravesh Vishwakarma, Rishi Sethi, Varun Shanker Narain, Sudhanshu Kumar Dwivedi
Department of Cardiology, King George’s Medical University; Uttar Pradesh-India

Objective: The concept of managing patients on the basis of culprit lesion characteristics is emerging. Atherosclerotic plaques are reported to be rare in young patients presenting with acute coronary syndrome (ACS). We aimed to assess culprit lesion characteristics in very young patients presenting with ACS by optical coherence tomography (OCT).
Methods: This was a prospective, single-center, open-label, observational study. Patients aged 35 years or less with ACS who underwent invasive coronary angiography and OCT were studied.
Results: Of the 43 patients, 22 (51.2%) had plaque rupture, 16 (37.2%) had plaque erosion, and five (11.6%) had no specific lesion character. Plaque was fibroatheromatous in 34 (79.1%) patients and fibrous in seven (16.3%). Plaque was not found in two (4.7%) patients; of these, one (2.3%) had left anterior descending coronary artery bridging, and one (2.3%) had intimal dissection without any plaque. Plaque rupture was more commonly associated with fibroatheromatous plaques, whereas plaque erosion was more commonly associated with fibrous plaque (p=0.010).
Conclusion: Although plaque rupture and plaque erosion occurred at the same rate as seen in patients of all ages, calcified nodule as a culprit lesion was not found in young patients. Majority of the patients had plaque rupture and plaque erosion with fibroatheromatous plaque, signifying the occurrence of established coronary artery disease in very young patients of Southeast Asia.

Keywords: acute coronary syndrome, optical coherence tomography, plaque erosion, plaque rupture, ST-segment elevation myocardial infarction

Sharad Chandra, Snigdha Boddu, Gaurav Chaudhary, Akhil Sharma, Akshyaya Pradhan, Monika Bhandari, Pravesh Vishwakarma, Rishi Sethi, Varun Shanker Narain, Sudhanshu Kumar Dwivedi. Culprit lesion characteristics in very young patients with acute coronary syndrome: An optical coherence tomography study. Anatol J Cardiol. 2021; 25(10): 684-690

Corresponding Author: Gaurav Chaudhary, India
Manuscript Language: English


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