Objectives: The concept of managing patients based on culprit lesion character 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
Results: Of the 43 patients, 22 (51.2%) patients had plaque rupture, 16 (37.2%) had plaque erosion, and 5 (11.6%) had no specific lesion character. Plaque was fibroatheromatous in 34 (79.1%) patients and fibrous in 7 (16.3%) patients. Plaque was not found in 2 (4.7%) patients; of these, 1 (2.3%) patient had left anterior descending coronary artery bridging, and 1 (2.3%) patient had intimal dissection without any plaque. Plaque rupture was more commonly associated with fibroatheromatous plaques, while 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 South-east Asia.