Characteristics of non‐culprit plaques in acute coronary syndrome patients with calcified plaque at the culprit lesion

Abstract Objectives To investigate the non‐culprit plaques (NCPs) characteristics in acute coronary syndrome (ACS) patients with calcified plaques (CP). Background Recently, a new in vivo classification of calcified culprit plaques in patients with ACS was proposed. Characteristics of NCPs in this group of patients are unknown. Methods A total of 692 NCPs from 492 ACS patients were retrospectively compared based on the culprit plaque phenotype: 71 from CP patients, 383 from plaque rupture (PR) patients, 238 from plaque erosion (PE) patients. Results NCPs of CP patients had greater maximal calcium thickness, wider calcium arc, longer calcium length, and greater calcium index, compared to PR or PE patients (CP vs. PR: all p < .001, CP vs. PE: all p < .001). Thin‐cap fibroatheroma was less prevalent ( p = .023), fibrous cap was thicker ( p = .035), and mean lipid arc was narrower in CP than in PR ( p < .001). Conclusions In conclusion, NCPs of CP patients had greater calcium burden and less vulnerability. This information may help to better understand the underlying mechanisms of ACS and to develop strategy for tailored management.