Top

Published in:

01-05-2021 | ST-Segment Elevation Myocardial Infarction

Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome

Authors: Osamu Kurihara, Masamichi Takano, Tsunekazu Kakuta, Tsunenari Soeda, Filippo Crea, Tom Adriaenssens, Holger M. Nef, Niklas F. Boeder, Erika Yamamoto, Hyung Oh Kim, Michele Russo, Iris McNulty, Makoto Araki, Akihiro Nakajima, Hang Lee, Kyoichi Mizuno, Ik -Kyung Jang

Published in: Journal of Thrombosis and Thrombolysis | Issue 4/2021

Abstract

Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P < 0.001), and the incidence of STEMI caused by PE was significantly lower on antiplatelet therapy (P < 0.001) or on statin therapy (P < 0.001). Antiplatelet therapy is associated with lower probability of STEMI, regardless of underlying pathology, and statin therapy is associated with lower probability of STEMI in PE as clinical presentation of ACS.

Graphic Abstract

Statin therapy prior to the onset of acute coronary syndromes (ACS) may reduce the probability of plaque rupture. Antiplatelet therapy prior to the onset of ACS is associated with reduced probability of ST-segment elevation myocardial infarction (STEMI) following both plaque rupture and plaque erosion, and dual antiplatelet therapy offers additional protection compared to a single antiplatelet agent in plaque erosion. The combination of statin and antiplatelet therapy may have an additive effect on reducing the probability of STEMI caused by plaque erosion.

Yellow: lipid pool(necrotic core); red: fibrin-rich thrombus; gray; platelet-rich thrombus

Available only for authorised users

Davies MJ (2000) The pathophysiology of acute coronary syndromes. Heart 83:361–366. https://doi.org/10.1136/heart.83.3.361CrossRefPubMedPubMedCentral

Bentzon JF, Otsuka F, Virmani R, Falk E (2014) Mechanisms of plaque formation and rupture. Circ Res 114:1852–1866. https://doi.org/10.1161/CIRCRESAHA.114.302721CrossRefPubMed

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, Group ESCSD (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41:407–477. https://doi.org/10.1093/eurheartj/ehz425CrossRefPubMed

Rich JD, Cannon CP, Murphy SA, Qin J, Giugliano RP, Braunwald E (2010) Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol 56:1376–1385. https://doi.org/10.1016/j.jacc.2010.06.028CrossRefPubMed

Spencer FA, Allegrone J, Goldberg RJ, Gore JM, Fox KA, Granger CB, Mehta RH, Brieger D, Investigators G (2004) Association of statin therapy with outcomes of acute coronary syndromes: the GRACE study. Ann Intern Med 140:857–866. https://doi.org/10.7326/0003-4819-140-11-200406010-00006CrossRefPubMed

Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK (2013) In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol 62:1748–1758. https://doi.org/10.1016/j.jacc.2013.05.071CrossRefPubMed

Kolodgie FD, Burke AP, Wight TN, Virmani R (2004) The accumulation of specific types of proteoglycans in eroded plaques: a role in coronary thrombosis in the absence of rupture. Curr Opin Lipidol 15:575–582. https://doi.org/10.1097/00041433-200410000-00012CrossRefPubMed

Sato Y, Hatakeyama K, Yamashita A, Marutsuka K, Sumiyoshi A, Asada Y (2005) Proportion of fibrin and platelets differs in thrombi on ruptured and eroded coronary atherosclerotic plaques in humans. Heart 91:526–530. https://doi.org/10.1136/hrt.2004.034058CrossRefPubMedPubMedCentral

Damman P, de Winter RJ (2017) Timing of revascularisation for acute coronary syndrome. Lancet 390:717–718. https://doi.org/10.1016/S0140-6736(17)31632-XCrossRefPubMed

10.

Ino Y, Kubo T, Tanaka A, Kuroi A, Tsujioka H, Ikejima H, Okouchi K, Kashiwagi M, Takarada S, Kitabata H, Tanimoto T, Komukai K, Ishibashi K, Kimura K, Hirata K, Mizukoshi M, Imanishi T, Akasaka T (2011) Difference of culprit lesion morphologies between st-segment elevation myocardial infarction and non-st-segment elevation acute coronary syndrome: an optical coherence tomography study. JACC Cardiovasc Interv 4:76–82. https://doi.org/10.1016/j.jcin.2010.09.022CrossRefPubMed

11.

Yonetsu T, Lee T, Murai T, Kanno Y, Hamaya R, Ichijo S, Niida T, Hada M, Araki M, Matsuda J, Usui E, Hoshino M, Kanaji Y, Kakuta T (2017) Association between prior aspirin use and morphological features of culprit lesions at first presentation of acute coronary syndrome assessed by optical coherence tomography. Circ J 81:511–519. https://doi.org/10.1253/circj.CJ-16-0957CrossRefPubMed

12.

Amabile N, Hammas S, Fradi S, Souteyrand G, Veugeois A, Belle L, Motreff P, Caussin C (2015) Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses. Eur Heart J Cardiovasc Imaging 16:433–440. https://doi.org/10.1093/ehjci/jeu228CrossRefPubMed

13.

Barrabes JA, Galian L (2010) Endogenous thrombolysis: a hidden player in acute coronary syndromes? J Am Coll Cardiol 55:2116–2117. https://doi.org/10.1016/j.jacc.2010.01.034CrossRefPubMed

14.

Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–1860. https://doi.org/10.1016/S0140-6736(09)60503-1CrossRefPubMed

15.

Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H (2002) Warfarin, aspirin, or both after myocardial infarction. N Engl J Med 347:969–974. https://doi.org/10.1056/NEJMoa020496CrossRefPubMed

16.

Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, Xu M, Yao Y, Hu S, Yamamoto E, Lee H, Zhang S, Yu B, Jang IK (2017) Effective anti-thrombotic therapy without stenting: Intravascular optical coherence tomography-based management in plaque erosion (the erosion study). Eur Heart J 38:792–800. https://doi.org/10.1093/eurheartj/ehw381CrossRefPubMed

17.

Sugiyama T, Xing L, Yamamoto E, Fracassi F, Lee H, Yu B, Jang IK (2018) Thrombus resolution with tirofiban in the conservative management of patients presenting with plaque erosion. Coron Artery Dis 29:301–308. https://doi.org/10.1097/MCA.0000000000000614CrossRefPubMed

18.

Schartl M, Bocksch W, Koschyk DH, Voelker W, Karsch KR, Kreuzer J, Hausmann D, Beckmann S, Gross M (2001) Use of intravascular ultrasound to compare effects of different strategies of lipid-lowering therapy on plaque volume and composition in patients with coronary artery disease. Circulation 104:387–392. https://doi.org/10.1161/hc2901.093188CrossRefPubMed

19.

Komukai K, Kubo T, Kitabata H, Matsuo Y, Ozaki Y, Takarada S, Okumoto Y, Shiono Y, Orii M, Shimamura K, Ueno S, Yamano T, Tanimoto T, Ino Y, Yamaguchi T, Kumiko H, Tanaka A, Imanishi T, Akagi H, Akasaka T (2014) Effect of atorvastatin therapy on fibrous cap thickness in coronary atherosclerotic plaque as assessed by optical coherence tomography: The easy-fit study. J Am Coll Cardiol 64:2207–2217. https://doi.org/10.1016/j.jacc.2014.08.045CrossRefPubMed

20.

von Birgelen C, Klinkhart W, Mintz GS, Wieneke H, Baumgart D, Haude M, Bartel T, Sack S, Ge J, Erbel R (2000) Size of emptied plaque cavity following spontaneous rupture is related to coronary dimensions, not to the degree of lumen narrowing. A study with intravascular ultrasound in vivo. Heart 84:483–488. https://doi.org/10.1136/heart.84.5.483CrossRef

21.

Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK (2008) In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 29:1721–1728. https://doi.org/10.1093/eurheartj/ehn286CrossRefPubMedPubMedCentral

22.

Scalone G, Niccoli G, Refaat H, Vergallo R, Porto I, Leone AM, Burzotta F, D'Amario D, Liuzzo G, Fracassi F, Trani C, Crea F (2017) Not all plaque ruptures are born equal: an optical coherence tomography study. Eur Heart J Cardiovasc Imaging 18:1271–1277. https://doi.org/10.1093/ehjci/jew208CrossRefPubMed

23.

Libby P, Pasterkamp G, Crea F, Jang IK (2019) Reassessing the mechanisms of acute coronary syndromes. Circ Res 124:150–160. https://doi.org/10.1161/CIRCRESAHA.118.311098CrossRefPubMedPubMedCentral

24.

Ferrante G, Nakano M, Prati F, Niccoli G, Mallus MT, Ramazzotti V, Montone RA, Kolodgie FD, Virmani R, Crea F (2010) High levels of systemic myeloperoxidase are associated with coronary plaque erosion in patients with acute coronary syndromes: a clinicopathological study. Circulation 122:2505–2513. https://doi.org/10.1161/CIRCULATIONAHA.110.955302CrossRefPubMed

25.

Kessinger CW, Kim JW, Henke PK, Thompson B, McCarthy JR, Hara T, Sillesen M, Margey RJ, Libby P, Weissleder R, Lin CP, Jaffer FA (2015) Statins improve the resolution of established murine venous thrombosis: Reductions in thrombus burden and vein wall scarring. PLoS ONE 10:e0116621. https://doi.org/10.1371/journal.pone.0116621CrossRefPubMedPubMedCentral

26.

Mayyas F, Baydoun D, Ibdah R, Ibrahim K (2018) Atorvastatin reduces plasma inflammatory and oxidant biomarkers in patients with risk of atherosclerotic cardiovascular disease. J Cardiovasc Pharmacol Ther 23:216–225. https://doi.org/10.1177/1074248417753677CrossRefPubMed

27.

Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K, Sakamoto T, Tsujita K, Hagiwara N, Miyazaki S, Ako J, Arai H, Ishii H, Origuchi H, Shimizu W, Takemura H, Tahara Y, Morino Y, Iino K, Itoh T, Iwanaga Y, Uchida K, Endo H, Kongoji K, Sakamoto K, Shiomi H, Shimohama T, Suzuki A, Takahashi J, Takeuchi I, Tanaka A, Tamura T, Nakashima T, Noguchi T, Fukamachi D, Mizuno T, Yamaguchi J, Yodogawa K, Kosuge M, Kohsaka S, Yoshino H, Yasuda S, Shimokawa H, Hirayama A, Akasaka T, Haze K, Ogawa H, Tsutsui H, Yamazaki T (2019) JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome. Circ J 83:1085–1196. https://doi.org/10.1253/circj.CJ-19-0133CrossRefPubMed

28.

Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fracassi F, Sugiyama T, Lee H, Crea F, Kimura T, Fujimoto JG, Fuster V, Jang IK (2019) Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes. J Am Heart Assoc 8:e012322. https://doi.org/10.1161/JAHA.119.012322CrossRefPubMedPubMedCentral

29.

Zheng SL, Roddick AJ (2019) Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA 321:277–287. https://doi.org/10.1001/jama.2018.20578CrossRefPubMedPubMedCentral

30.

Wascher TC (2003) Long-term statin safety and efficacy in secondary prevention: can combination therapy improve outcomes? Atheroscler Suppl 4:11–16. https://doi.org/10.1016/s1567-5688(03)90002-xCrossRefPubMed

31.

Hennekens CH, Sacks FM, Tonkin A, Jukema JW, Byington RP, Pitt B, Berry DA, Berry SM, Ford NF, Walker AJ, Natarajan K, Sheng-Lin C, Fiedorek FT, Belder R (2004) Additive benefits of pravastatin and aspirin to decrease risks of cardiovascular disease: randomized and observational comparisons of secondary prevention trials and their meta-analyses. Arch Intern Med 164:40–44. https://doi.org/10.1001/archinte.164.1.40CrossRefPubMed

Title: Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome
Authors: Osamu Kurihara
Masamichi Takano
Tsunekazu Kakuta
Tsunenari Soeda
Filippo Crea
Tom Adriaenssens
Holger M. Nef
Niklas F. Boeder
Erika Yamamoto
Hyung Oh Kim
Michele Russo
Iris McNulty
Makoto Araki
Akihiro Nakajima
Hang Lee
Kyoichi Mizuno
Ik -Kyung Jang
Publication date: 01-05-2021
Publisher: Springer US
Keywords: ST-Segment Elevation Myocardial Infarction
Acute Coronary Syndrome
Published in: Journal of Thrombosis and Thrombolysis / Issue 4/2021
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-020-02281-7

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Graphic Abstract

Please log in to get access to this content

Other articles of this Issue 4/2021

Hemorrhagic lesions associated with anticoagulant therapy: a pictorial review

Risk factors for intracerebral hemorrhage in patients with COVID-19

Markers of coagulation dysfunction and inflammation in diabetic and non-diabetic COVID-19

Pulmonary thrombosis in Covid-19: before, during and after hospital admission

Thromboelastography findings in critically ill COVID-19 patients

Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials