To explore the application value of optical coherence tomography (OCT) in layered coronary plaque lesions in acute myocardial infarction (AMI).

From January 2019 to October 2022, 60 patients diagnosed with AMI due to plaque erosion after undergoing coronary angiography (CAG) and OCT on target vessels at the Cardiovascular Department of Jilin Central Hospital were collected. Based on OCT image findings, the patients were categorized into a layered plaque erosion group (28 cases) and a non-layered plaque erosion group (32 cases). The 2 groups of patients′ demographic data, previous disease history, cardiovascular medication history, clinical biochemical data, CAG data and OCT data were all compared.

In 60 cases of AMI patients, 28 cases had layered plaque erosion, accounting for 46.67%. In the layered plaque erosion group, the levels of low-density lipoprotein [(3.38±0.27)mmol/L] and glycosylated hemoglobin [(7.38±0.24)%]were significantly higher than those in non-layered plaque erosion patients [(2.42±0.15)mmol/L, (6.00±0.58)%], and the differences were statistically significant (t=6.00, 3.23, all P<0.05). CAG showed that compared to non-layered plaque erosion group, the erosion of layered plaques were more commonly seen in the left anterior descending branch of the coronary artery [18/28(64.29%), 12/32(37.50%)], with longer lesion lengths [(28.64±4.38)mm, (15.23±4.32)mm], and more complex lesions (B2/C type) [16/28(57.14%), 8/32(25.00%)], and the differences were statistically significant (χ²=4.29, t=11.92, χ²=6.43, all P<0.05). Regarding OCT characteristics of target vessels, comparing to non-layered plaque erosion group, the fibrous cap was thinner [(91.78±7.89)μm, (120.89±7.18)μm], the lipid plaque radian was larger [(270.21±59.89)°, (206.58±58.61)°], the minimum lumen area (MLA) was smaller [(1.25±0.21)mm^2, (1.77±0.24)mm²], and the degree of vascular stenosis was more severe [(88.38±9.56)%, (76.45±8.38)%] in layered plaque erosion group (t=14.96, 2.48, 8.87, 2.56, all P<0.05). Compared to those in non-layered plaque erosion group, the macrophages [19/28(67.86%), 12/32(37.50%)], nourishing vessels [8/28(28.57%), 2/32(6.25%)], cholesterol crystallization [15/28(53.57%), 8/32(25.00%)], clot burden [25/28(89.29%), 21/32(65.63%)], and thin-cap fibroatheroma [20/28(71.43%), 14/32(43.75%)] were found more frequently in layered plaque erosion group (χ²=5.51, 3.87, 5.16, 4.67, 4.66, all P<0.05). The stent length [(30.00±5.64)mm, (18.00±7.42)mm], stent expansion ratio [14/28(50.00%), 8/32(25.00%)], stent malapposition [12/28(42.86%), 6/32(18.75%)] were significantly different between the layered plaque erosion and non-layered plaque erosion in AMI patients (t=9.32, χ²=4.02, 3.87, all P<0.05). Compared to non-layered plaque erosion group, AMI patients with layered plaque erosion might have more aggressive post-dilatations [22/28(78.57%), 10/32(31.25%)], and have higher post stent expansion pressure [(18.00±2.68)atm, (14.00±2.46)atm] (1 atm=101.3 kPa) (χ²=4.25, t=2.47, all P<0.05). In the 2 groups, the accumulated major adverse cardiovascular events (MACE) at 12 months postoperatively were related to target vessel revascularization, with 1 case and 2 cases, respectively. The target vessel revascularization rate in the layered plaque erosion group(2/28, 7.14%) was higher than that in the non-layered plaque erosion group (1/32, 3.13%), but the difference was not statistically significant (P=0.594).

The erosion of layered plaques is closely related to the characteristics of lesions and clinical manifestations of patients. OCT has potential application prospects in evaluating the therapeutic effects of PCI in AMI patients with eroded layered plaques, providing personalized treatment guidance.