Background
Patients with familial hypercholesterolemia (FH) experience acute coronary syndrome (ACS) at a younger age and have a higher risk of recurrent coronary events. The study aimed to elucidate the morphological characteristics of coronary plaques including the status of macrophages in patients with FH.
Methods
This study included 259 patients with ACS who underwent optical coherence tomography (OCT) imaging of culprit plaques requiring percutaneous coronary intervention. The characteristics of culprit plaques and non-culprit plaques in the same coronary artery were compared between patients with and without FH.
Results
A total of 23 patients (8.9 %) were clinically diagnosed with FH. In culprit plaques, the prevalence of both plaque with macrophages (69.6 % vs. 49.6 %, p = 0.081) and plaque with greater macrophage activity (macrophage grade ≥2) (65.0 % vs. 43.9 %, p = 0.099) was numerically higher in patients with FH than in those without FH. In non-culprit plaques, the prevalence of both plaque with macrophages (71.4 % vs. 42.0 %, p = 0.046) and plaque with greater macrophage activity (42.9 % vs. 16.0 %, p = 0.021) was significantly higher in patients with FH than in those without FH. The higher prevalence of layered plaques (78.6 % vs. 37.8 %, p = 0.008) in patients with FH than in those without FH was observed in non-culprit plaques.
Conclusions
FH patients with ACS had more coronary plaques with macrophages, particularly in non-culprit segments, which may partly explain the increased risk of recurrent coronary events.
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