Correlation between layered plaques and adverse prognosis in patients with acute coronary syndrome

YAN Meng-xiang; ZHAO Qian; LIU Fen; LI Xiao-mei; YANG Yi-ning

doi:10.3969/j.issn.1672-5301.2025.11.010

Abstract：Objective To investigate the association of the layered plaque using optical coherence tomography(OCT)with major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS).Methods A total of 222 patients with acute coronary syndrome(ACS),who were consecutively enrolled from January 2018 to January 2023 at the Cardiac Center of the First Affiliated Hospital of Xinjiang Medical University and underwent both coronary angiography(CAG)and optical coherence tomography(OCT)examinations,were included in this study.Among them,5 patients were lost to follow-up,and 217 patients completed a 24-month follow-up.The occurrence of endpoint events was evaluated through telephone interviews or outpatient visits.Based on OCT imaging characteristics,patients were firstly classified into two groups:the layered plaque group(n=108)and non-layered plaque group(n=109).Then,the baseline characteristics,biochemical profiles and OCT plaque features were compared between the 2 groups.Finally,Kaplan-Meier survival curves were plotted and compared using the Log-rank test.The independent predictive value of layered plaques for MACE was assessed using a Cox proportional hazards regression model after adjusting for confounding factors.Results The serum uric acid level was significantly higher but the serum albumin level was significantly lower in the layered plaque group than in the non-layered plaque group(P<0.05).Regarding OCT characteristics,the layered plaque group had a significantly thinner fibrous cap[75.0(40.0,180.0)μm vs.120.0(60.0,200.0)μm,P<0.05],a higher lipid index[1735.0(762.5,2906.2)vs.1272.0(852.0,1758.0),P<0.05],a longer lesion length[(12.6±5.4)mm vs.(10.2±4.2)mm,P<0.05],and a smaller minimum lumen area[(1.9±0.6)mm²vs.(2.1±0.6)mm²,P<0.05].The detection rates of macrophage infiltration,cholesterol crystals,thrombus and calcified nodules were all significantly higher in the layered plaque group(P<0.05).The median follow-up duration was 21.5 months for the 217 patients.After adjustment for variables including body mass index(BMI),low-density lipoprotein,creatinine,number of diseased vessels and minimum lumen area,multivariable Cox regression analysis demonstrated that layered plaque was an independent risk factor for MACE in ACS patients(HR=2.26,95%CI 1.163-4.398,P=0.016).Conclusion The layered plaque is an independent predictor of adverse outcomes in ACS patients,serving as a novel imaging biomarker for clinical risk stratification.