Layered plaques and coronary plaque vulnerability: an optical coherence tomography study

Layered plaques and coronary plaque vulnerability: an optical coherence tomography study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Layered plaques and coronary plaque vulnerability: an optical coherence tomography study Zening Yu, Qingjie Chen, Xiaomei Li, Yining Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3116615/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Layered plaques are a subclinical sign of plaque rupture or erosion, with plaque vulnerability and can be detected by optical coherence tomography (OCT). The study designed to evaluate the prevalence, angiographic, OCT characteristics of layered plaques in patients with acute coronary syndrome (ACS). Methods and results Consecutive ACS patients with 126 coronary culprit lesions underwent coronary angiography (CAG) and pre-intervention optical coherence tomography examination in this study. Patients were divided into layered plaque group (n = 57) and non-layered plaque group(n = 69) based on OCT plaque morphology. Layered plaque is heterogeneous signal-rich layered tissue of different optical signal intensity that close to the luminal surface, clearly demarcated from the underlying components on OCT. Patients with layered plaque were higher statin uptake rate compared to patients with non-layered plaque(P = 0.037). Uric acid (368.613 ± 91.840vs.327.901 ± 76.232µmol/L, P = 0.009) and Indirect bilirubin (IBil) (9.873 ± 5.252vs.8.130 ± 4.039, P = 0.037) level is higher in layered plaque group compare to patient with non-layered plaque. Longer lesion length in the layered plaque group compared with the non-layered plaque group (10(8,12) vs.8(5.5,10.0), P = 0.004). Higher lipid index (1400(631.5,2257) vs.1080(577.5,1455), P = 0.02)), Macrophage accumulation (49.1%vs.33.3%, P = 0.035) and TCFA (68.4%vs. 40.6%, P = 0.002) in the layered plaque group compared with the non-layered plaque group. Results of multivariate analyses showed that Uric acid was independent risk factors of layered plaque in our cohorts (P < 0.05). Conclusions This study demonstrate that layered plaques are associated with plaque vulnerability and progression of atherosclerosis at culprit lesions in patient with ACS. Acute coronary syndrome Layered plaque Healed plaque Optical coherence tomography Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Acute coronary syndrome (ACS) is often caused by acute and severe thrombosis subsequent to plaque rupture or plaque erosion resulting in interrupted coronary blood flow[ 1 ].However, in the majority of coronary atherosclerotic plaque progression, the thrombotic lesion is silent and has no clinical presentation [ 2 ].At this point the body may undergoes a repeated process of plaque repair[ 3 ].However, repeated plaque repair processes can increase coronary lumen narrowing and plaque loading, which represents plaque progression[ 4 ].Optical coherence tomography (OCT) is an intracoronary imaging technique in which layered plaque as a plaque that is clearly demarcated from the underlying components, close to the luminal surface, and consists of non-homogeneous signals in different optical density layers [ 5 , 6 ].Accordingly, layered plaques are a type of plaque in which previous plaque instability leads to repair, their presence often represents higher levels of inflammatory response and greater plaque vulnerability[ 7 , 8 ].Previous studies have shown that layered plaques are a bridge between stable angina pectoris(SAP)and acute coronary syndromes, with a higher probability of subsequent major adverse cardiovascular events(MACE)[ 9 , 10 ]. Identifying layered plaques can help in risk stratification for patients with high-risk plaque features[ 11 ]. In this study, we sought to explore the independent risk factors that predict layered plaque in patient with ACS based on OCT. Methods Study population The statistics show that from a total of 165 patients with coronary heart disease (CHD) who underwent pre-intervention OCT examination between January 2020 and January 2023. For this analysis, 39 patients were excluded for in-stent thrombosis (n = 12), stable angina pectoris(n = 15),extreme age (n = 2), the lack of preintervention OCT examinations (n = 5), poor imaging quality mainly due to massive thrombus (n = 5).Of these,126 patients were met inclusion criteria and were eligible for the study, the study flowchart is as shown in Fig. 1, and the diagnosis of ACS includes ST-segment elevation myocardial infarction(STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and Unstable angina (UA).The diagnostic criteria for ACS are based on previous guidelines[ 12 ]. Demographic features, clinical data, ACS risk factors, blood biochemical indicators, CAG and OCT results were evaluated. This study was approved by the Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University(K202306-05), all patients have signed an informed consent to participate. Blood tests All patients had peripheral blood drawn 8 hours prior to CAG in the fasting state. All quantitative tests, including white blood cell count, neutrophil count, lymphocyte count, platelet count, fibrinogen, D-dimer, triglycerides, total cholesterol, LDL, HDL, etc. are performed by our Laboratory Department using a Fully Automated Blood Cell Analyzer. Coronary angiography analysis Coronary angiography for all patients within 24 hours of admission, CAG and percutaneous coronary intervention (PCI) are mainly performed using the Judkins method with a radial approach. And the Angiographic analysis were performed by two 2 experienced cardiovascular physicians on baseline coronary angiograms acquired during the index. The location of lesion, type of lesion, diameter stenosis, and culprit lesion length were measured. The culprit lesion in ACS was defined as a combination of coronary angiographic findings, electrocardiographic changes, and/or abnormal left ventricular wall motion, with evidence of fractional flow reserve for ischaemia. The culprit lesion was defined as the degree of stenosis on coronary angiogram or the site of PCI. OCT image acquisition and measurement OCT was performed using the commercially available C7-XR OCT intravascular imaging system (C7-XRTM OCT Intravascular Imaging System, St. Jude Medical, St. Paul, MN, USA). Pullback speed was 20mm/s, and the total pullback distance of the system was 50 mm. All OCT images were analyzed by two independent investigators. During off-line review, the investigators was blinded to the patient data. Layered plaque as a layered plaque with heterogeneous signal-rich layered tissue of different optical signal intensity that close to the luminal surface, clearly demarcated from the underlying plaque[ 3 , 5 ]. Layered plaques have the same characteristics as healed plaques on OCT, so the terms “layered plaques” and “healed plaques” can be used interchangeably. According to the present guide consensus for OCT [ 13 ],Lipid plaque was defined as a diffusely bordered signal-poor region with an overlying signal rich band, and lipid arc was measured every 1 mm. Fibrous plaque was defined as a plaque with homogeneous, high back-scattering signal. Calcifications were defined as signal-poor or heterogeneous areas delimited by sharp borders. Thin-cap fibroatheroma (TCFA) was defined as plaque with Lipid content ≥ two quadrants and the fibrous cap thickness ≤ 65 µm. Plaque rupture was identified as intimal tearing, disruption, or dissection of the fibrous cap. Plaque erosion was defined by the presence of attached thrombus overlying an intact and visualized plaque or luminal surface irregularity at the culprit lesion in the absence of thrombus. Vasa vasorum appear as signal-poor voids that are sharply delineated and can usually be followed in multiple contiguous frames. Cholesterol crystals appear in OCT images as thin, linear regions of high intensity. Macrophage accumulation was defined as the presence of signal-rich, distinct, or confluent punctate regions and generate a backward shadowing[ 13 , 14 ]. Representative images of layered plaque and nonlayered plaque are shown in Fig. 2 . Statistical analysis All statistical analysis was performed using business software (SPSS 24.0 IBM, New York, NY, USA). Normally distributed continuous data were expressed as means and standard deviations, and Student t test was used for comparison between groups; non-normally distributed continuous data were expressed as median M (P25, P75) and Mann-Whitney U test was used for comparison between groups; categorical data were expressed as frequencies and percentages (%), and were compared using χ 2 test or Fisher exact tests. To assess whether baseline characteristics and plaque characters had an impact on layered plaque, Significant variables in the univariable model were included in the multivariable logistic regression model. And multivariable logistic regression model was also used to adjust confounders and calculate odds ratios (OR) and 95% confidence intervals (CI). p value < 0.05 was considered statistically significant. Results Baseline clinical characteristics Finally, Among 126 patients,57 (45.2%) patients had layered plaque at the culprit lesions, and the baseline patient characteristics based on the presence or absence of layered plaques between the two groups are summarized in Table 1. Patients with layered plaque were higher statin uptake rate compared to those non-layered plaque (100%vs.89.9%, P=0.037). No significant differences in clinical presentation, CHD history or other baseline data were observed between the two groups. Clinical biochemical indicators Table2 shows the Clinical biochemical indicators of the two groups. It is observed that patients with layered plaque has higher level Uric acid (368.613±91.840vs.327.901±76.232μmol/L, P=0.009) and Indirect bilirubin (9.873±5.252vs.8.130±4.039, P=0.037) compare to patient with non-layered plaque. No other laboratory variables were significantly different between two groups. Angiographic findings CAG findings of the included ACS patients according to the layered plaque are presented in Table 3. Longer lesion length in the layered plaque group compared with the non-layered plaque group (10(8,12) vs.8(5.5,10.0), P=0.004). There was no significant difference in other CAG findings between those two groups. Optical coherence tomography findings The optical coherence tomography analysis results are shown in Table 4. The layered plaque group had a higher lipid index compared to the non-layered group (1400(631.5,2257) vs.1080(577.5,1455), P=0.02)). Macrophage accumulation in the layered plaque group was higher compared to the non-layered plaque group (49.1%vs.33.3%, P=0.035). The incidence of TCFA was higher in the layered plaque group than in the non-layered plaque group (68.4%vs. 40.6%, P=0.002). OCT characteristics of layered plaque and non-layered plaque at the culprit lesion in fig3. Moreover, no statistical difference was detected for OCT findings between those two groups. Predictors for layered culprit plaque Table 5 shows the results of multivariable analysis. The following variables were included in the multivariable model: Diabetes mellitus, BMI, Uric acid, IBil. In the multivariable model, Uric acid, Lesion length, TCFA were independent predictors for layered culprit plaque(all p＜0.05). Prevalence of layered plaque in patients with ACS The prevalence of a layered plaque at the culprit lesion was compared among different clinical presentations in fig4. The prevalence of layered culprit plaque was significantly higher in patients with unstable angina pectoris. Discussion In the present study we demonstrated that layered plaques were associated with plaque vulnerability. Moreover, Uric acid was independently associated with coronary layered plaques. These findings suggest that Uric acid may be used as inexpensive markers for risk stratification in ACS patients. With the development of intracoronary imaging techniques, the ability to identify vulnerable plaques has gradually improved, with the advantage of OCT being its higher resolution, as an in vivo diagnostic modality with excellent sensitivity and specificity for detecting plaque morphology and vessel wall microstructure. The layered plaque consists mainly of proliferating smooth muscle cells forming loose type III collagen fibrils and proteoglycans, which then gradually transition to type I collagen fibrils and re-endothelialize. Histopathological layered plaques have a layered appearance on OCT views and are morphologically layered. The layered plaque reflects the repair process of previous plaque rupture and thrombus[15, 16], representing previous plaque instability. Plaque repair can cause further coronary lumen stenosis[17]. Layered plaques are generally observed in both SAP and ACS patients[18-20]. Previous studies have found that it is more common in patients with SAP. Because patients with stable angina have a greater weight of endogenous anti-thrombotic system, which is more resistant to thrombosis and prevents occlusive thrombus formation[21]. Our study found that layered plaques were mostly present in patients with unstable angina (71.9%vs. 21.8%，p＜0.001), which may be associated with more repair processes after plaque rupture or thrombosis. what is more, behind the formation of layered plaque is a greater vulnerability to plaque and inflammatory response, as more macrophage infiltration and TCFA presence is observed around the layered plaque, the presence of layered plaque is not a protective factor and may even be a possible acute thrombotic event in patients with ACS. From this it is clear that identify layered plaque is useful for optimizing the treatment of coronary artery disease and improve clinical outcomes for patients. Clinical and angiography data in layered plaque In an autopsy study, it was found that plaque ruptures were found in 61% of acute myocardial infarction who died suddenly of cardiac shock and were associated with layered plaque, silent plaque rupture is a form of wound healing that results in increased percent stenosis[22]. Mann and Davies reported that 73.2% of plaque types with luminal stenosis greater than 50% in ischaemic heart disease had layered plaques. Layered plaques also represent a higher degree of luminal stenosis and vulnerable plaque characteristics[23]. Our research also found longer lesion length in the layered plaque group compared with the non-layered plaque group. A retrospective observational study had discovered that higher lumen stenosis and lower stent expansion ratio and mean stent eccentricity index (SEI)when having layered plaque. Angiographically complex lesions (type B2/C) were more frequent in patients with layered culprit lesions[24]. In the present study, patients with stent implantation, there was a higher incidence of post-stenting failure and formation of in-stent atherosclerosis after stent expansion when possessing layered plaques[25]. Matsuo had also clarified layered plaques are positively correlated with lumen narrowing and plaque vulnerability[26]. An OCT and IVUS with iMap trial had shown that layered plaques were found in plaque rupture, suggesting that the risk of plaque rupture is higher when layered plaques are present. This shows that layered plaque can accelerate plaque progression[27]. Previous study finds hyperuricemia associated with plaque vulnerability, our research is consistent with this. Maybe associated with oxidative stress and endothelial damage caused by hyperuricemia. OCT data in layered plaque Russo discovered that patients with ACS had layered plaques ≥ 30% in the non-culprit lesions. And it was concluded that possession of layered plaques when composed of more macrophage infiltration, thinner fibrous cap, longer plaque length, longer lipid length and greater lipid index, further suggesting that having higher levels of inflammation when layered plaques are present [28]. In addition, our results showed that 28.1% AMI patient have layered plaques and layered plaques were associated with plaque vulnerability. In a 3-Vessel OCT Study, it was found that ACS caused by plaque erosion, followed by the formation of layered plaques, the combination of layered plaques at the site of plaque erosion had smaller minimal lumen area and greater degree of luminal stenosis. Both the culprit and non-culprit lesions, patients with layered plaque at the culprit site had higher incidence of lipid plaque, microchannels, cholesterol crystals, calcification than those without. Layered plaque is more likely to lead to adverse cardiovascular events later in the process[29]. A recent OCT study has demonstrated that layered plaques were detected in 74.5% of patients with ACS, and associated with thin-cap fibroatheromas[30]. Russo et al had reported that combined a layered plaque at the culprit vessel, greater plaque vulnerability, higher prevalence of calcifications, heavier lipid plaque and greater macrophage infiltration in possession of the layered plaque, suggesting that layered plaques are associated with vulnerable plaques again[19]. An OCT study investigating layered plaque in non-culprit lesions（NCLs）show that NCLs with layered plaque had more lipid-rich plaque, macrophage accumulations, microvessels and spotty calcification compared to NCLs without layered plaque[11]. Clinical outcomes with layered plaque Araki reported that a new layer was detected in 25 of 41 plaques at follow-up in stable angina patient, and the presence of layered plaque is strongly associated with the occurrence of major adverse cardiovascular events after PCI, identified layered plaque as predictors of subsequent rapid lesion progression. but the exact mechanism is unclear[31]. In a large cohort study that included 726 non-culprit lesions which had undergone PCI, 21.9% of them were found to have layered plaques. Ischemia-driven revascularization (IDR) was found in up to 65 cases over a 2-year follow-up period. This leads to the conclusion that untreated layered plaque in PCI target vessel was present in 21.9% of patients and it was related to future non-culprit-related events[11]. the interaction of layered plaque with MACE still needs further study to clarify its specific mechanism. Limitations There are several limitations to this paper. First, this paper is a single-center retrospective study with a small sample size and average strength of argument, and larger clinical studies are needed to confirm the argument; second, only plaque characteristics of culprit vessels were included in this paper, and non-culprit vessels were not examined by OCT and therefore were not included in the study design and not all patients underwent 3-vessel OCT imaging.However, in clinical practice, OCT of 3 vessels is less commonly performed.Moreover it is sometimes difficult to distinguish layered plaques from other plaque components. However, in our study, there was greater interobserver agreement in the observation of layered plaques. Prognosis of patients not included, further research is needed on the correlation between layered plaques and long-term prognosis. Conclusion In patients with ACS, Uric acid was a predictor for layered plaques at culprit lesions. Layered plaques are prevalent and have more features of vulnerability and accelerated progression of atherosclerosis at culprit lesions. Declarations Ethics approval and consent to participate The study protocol was approved by the ethics committee of the First affiliated hospital of Xinjiang Medical University. All methods were performed in accordance with the relevant guidelines and regulations. Because of the retrospective design of the study, the need to obtain informed consent from eligible patients was waived by the ethics committee of the First affiliated hospital of Xinjiang Medical University. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the First Affiliated Hospital of Xinjiang Medical University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the First Affiliated Hospital of Xinjiang Medical University. The permission to access and use the raw data was obtained from Zening Yu. Competing interests The authors declare that they have no competing interest. Funding This work was supported by a project grant from University Research Programme in Xinjiang Uygur Autonomous Region(XJEDU2021I015). This study was supported by research grants from the First Affiliated Hospital of Xinjiang Medical University to Dr. Yang Yining. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors' contributions Conceived and designed the study: YY and YZ. Data collection and analyzed the data: YZ. Quality control the study and revision:CQ,LX,YY. Wrote the paper: YZ. The manuscript was approved by all above authors. Acknowledgements Not Applicable. 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Tables Table1 Baseline data Variables Layered plaque(n=57) Non-layered plaque(n=69) t /𝜒 2 P value Age, years 60.40±10.13 59.43±9.85 0.541 0.590 Male 48(84.2) 49(71.0) 3.068 0.08 Hypertension 38(66.7) 44(63.8) 0.115 0.734 Diabetes mellitus 14(24.6) 18(26.1) 0.038 0.845 Current smoking 27(47.4) 31(44.9) 0.075 0.784 Current drinking 21(36.8) 16(23.2) 2.805 0.094 Family history of CAD 12(21.1) 16(23.2) 0.009 0.925 BMI, kg/m 2 26.37±2.93 26.45±3.68 0.134 0.893 Clinical presentation 2.727 0.099 AMI 16(28.1) 11(15.9) UAP 41(71.9) 58(84.1) Medications Aspirin 57(100) 64(92.8) 2.610 0.163 Statins 57(100) 62(89.9) 4.342 0.037 β-Blockers 42(73.7) 51(73.9) 0.001 0.977 ACEI/ARB 33(57.9) 39(56.5) 0.24 0.877 CCB 27(47.4) 29(42.0) 0.360 0.548 Values are presented as n (%), or mean ± SD; CAD, Coronary artery disease; BMI, body mass index; UAP, unstable angina pectoris; AMI, acute myocardial infarction. Table 2 Biochemical indices Variables Layered plaque(n=57) Non-layered plaque(n=69) t /𝜒 2 / Z P value WBC count, ×10 9 L -1 7.268±1.970 6.804±1.929 1.331 0.186 RBC count, ×10 9 L -1 4.659±0.447 4.633±0.590 0.268 0.789 PLT count, ×10 9 L -1 235.370±50.651 229.960±53.809 0.580 0.563 Neutrophil count, ×10 9 L -1 4.571±1.980 4.325±1.694 0.753 0.453 Lymphocyte count, ×10 9 L -1 1.931±0.616 1.910±0.620 0.193 0.847 HGB, g/L 139.350±13.474 140.960±15.956 0.603 0.548 Albumin, g/L 42.786±4.410 42.046±3.144 1.065 0.290 Fibrinogen, g/L 0.750(0.425,2.280) 0.820(0.460,2.370) 0.453 0.650 D-dimer, mg/L 88(54,151.5) 95(56,159) 0.620 0.535 Creatinine, μmol/L 76.726±23.524 82.191±29.525 0.405 0.686 Carbamide, mmol/L 6.011±1.539 5.753±2.844 0.613 0.541 Uric acid, μmol/L 368.613±91.840 327.901±76.232 2.672 0.009 eGFR 95.064±19.683 95.179±17.267 0.035 0.972 TBil, mmol/L 14.205±5.692 12.863±4.249 1.473 0.144 DBil, mmol/L 0.300(0.3,2.67) 0.300(0.3,3.45) 0.477 0.633 IBil, mmol/L 9.873±5.252 8.130±4.039 2.105 0.037 ALT, U/L 26.60(18.970,33.225) 25.50(19.600,33.340) 0.201 0.841 AST, U/L 26.09(18.950,40.110) 28.06(12.170,39.245) 0.179 0.858 TC, mmol/L 3.77±1.085 3.670±1.090 0.548 0.585 TG, mmol/L 1.81 1.47 0.735 0.462 LDL-C, mmol/L 2.219±0.876 2.203±0.905 0.099 0.921 HDL-C, mmol/L 1.009±0.214 0.920±0.288 1.917 0.058 Values are presented as n (%), or mean ± SD; WBC, white blood cell; RBC, red blood cell; PLT, Platelet; HGB, hemoglobin; TBil, total bilirubin; DBiL, direct bilirubin; IBiL, unconjugated bilirubin; ALT, alanine aminotransferase; AST, aspartate transaminase TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol. Table 3 Angiographic findings Variables Layered plaque(n=57) Non-layered plaque(n=69) t /𝜒 2 / Z P value Target vessel 2.795 0.424 LAD 44(77.2) 50(72.5) LCX 9(15.8) 10(14.5) RCA 4(7.0) 9(13.0) Number of vascular lesions 0.267 0.875 1 32(56.1) 36(52.2) 2 12(21.1) 17(24.6) 3 13(22.8) 16(23.2) Location of target plaque 1.005 0.605 Proximal 39(68.4) 52(75.4) Mid 15(26.3) 13(18.8) Distal 3(5.3) 4(5.8) Diameter stenosis, % 80(67.5,90.0) 80(60,90) 0.062 0.951 Lesion length，mm 10(8,12) 8(5.5,10.0) 2.882 0.004 Values are presented as n (%), or mean ± SD; LAD, Left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery. Table 4 OCT findings Variables Layered plaque(n=57) Non-layered plaque(n=69) t /𝜒 2 / Z P value FCT, μm 130(50,200) 120(60,200) 0.241 0.810 Lipid arc, degree 148(108.5,209.5) 135(88.5,179.00) 1.538 0.124 Lipid index 1400(631.5,2257) 1080(577.5,1455) 2.334 0.02 Macrophage accumulation 8.578 0.035 0 16(28.1) 36(52.2) 1 28(49.1) 23(33.3) 2 9(15.8) 10(14.5) 3 4(7.0) 1(1.5) 4 0(0) 0(0) Cholesterol crystals 30(52.6) 27(39.1) 2.297 0.130 Vasa vasorum 27(47.4) 26(37.7) 1.202 0.273 Thrombus 8(14.0) 9(13.0) 0.026 0.871 Calcified nodule 10(17.5) 5(7.2) 3.156 0.076 Characteristic of plaque 2.553 0.466 Lipid 32(56.1) 46(66.7) Calcified 9(15.8) 5(7.3) Fibrotic 16(28.1) 19(27.5) TCFA 39(68.4) 28(40.6) 9.717 0.002 plaque rupture 6(10.5) 4(5.80) 0.418 0.518 plaque erosion 2(3.5) 7(10.1) 1.193 0.275 MLA, mm 2 1.77(1.30,2.50) 2.10(1.62,2.57) 1.694 0.09 NLA, mm 2 7.78(6.32,8.89) 7.93(6.84,9.34) 0.647 0.518 Values are presented as n (%), or mean ± SD; OCT optical coherence tomography; FCT, fibrous cap thickness; TCFA, thin-cap fibroatheroma; MLA, minimal lumen area; NLA, normal lumen area Table5 multivariate logistic regression for layered plaque Multivariate analysis OR (95% CI) p value Uric acid 1.006(1.001-1.011) 0.012 IBil 1.081(0.996-1.173) 0.063 Diabetes mellitus 2.601(0.404-2.173) 0.937 BMI 0.975(0.870-1.092) 0.658 OR, odds ratio; CI, confidence interval. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3116615","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":220276291,"identity":"94a48169-38df-40a0-a868-d57aefa7bf2e","order_by":0,"name":"Zening Yu","email":"","orcid":"","institution":"the First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zening","middleName":"","lastName":"Yu","suffix":""},{"id":220276292,"identity":"5e65ad2c-7505-4a09-b75a-80d3cec2b1e0","order_by":1,"name":"Qingjie Chen","email":"","orcid":"","institution":"the First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qingjie","middleName":"","lastName":"Chen","suffix":""},{"id":220276293,"identity":"eaca1b7d-5fb2-48e6-a585-0ec12071d8e7","order_by":2,"name":"Xiaomei Li","email":"","orcid":"","institution":"the First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaomei","middleName":"","lastName":"Li","suffix":""},{"id":220276294,"identity":"bef343b7-66e6-4ee5-9581-6ca837dd0e44","order_by":3,"name":"Yining Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYPCCfzz87M0HDnz4QbyWAzKSPccSD87sIUGLjcENH+PDHGxEqDU4fvbwa94dd3gYbvB8OMzAwyDPL3aAgJYzeWnWvGee8TDO7t1wuMCCwXDm7AQCWg7kmBnztjHzMMuc3XB4Bg9DgsFtQlrOv4FoYZPIeXCYh40YLTdyjB/zth3m4ZHIYSBOi+SNN2aMc9vSeCR4jhkAA1mCsF/4zucYf3jbZmNvf7z58YcPP2zk+aUJaFE4wMAmxYPgS+BXDgLyDQzMH0lIJqNgFIyCUTASAQBrUkqctOIIEQAAAABJRU5ErkJggg==","orcid":"","institution":"Xinjiang Uygur Autonomous Region People's Hospital Urumqi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yining","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2023-06-27 15:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3116615/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3116615/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":40540866,"identity":"ab079bcb-a55a-459e-98eb-d75574b77e18","added_by":"auto","created_at":"2023-07-25 14:04:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28330,"visible":true,"origin":"","legend":"\u003cp\u003eA study flow chart of enrollment\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3116615/v1/410c72784ff8696a27b7c8f5.png"},{"id":40539482,"identity":"f6cd6e4e-bb03-4447-8aa5-c7fd0cde5839","added_by":"auto","created_at":"2023-07-25 13:56:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":684101,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative OCT images. Panel A shows a representative case of a layered plaque at the culprit lesion. Panel B shows a representative case of nonlayered plaque at the culprit lesion.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3116615/v1/ee121ee9bf0f4b0fb1b172ed.png"},{"id":40539480,"identity":"e4b60ad3-523c-4450-a49c-a34cc86e87c4","added_by":"auto","created_at":"2023-07-25 13:56:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24192,"visible":true,"origin":"","legend":"\u003cp\u003eOCT characteristics of layered plaque and non-layered plaque at the culprit lesion. Lipid index was higher in layered plaque than in non-layered plaque (1400(631.5,2257) vs.1080(577.5,1455), P=0.02)). Macrophage accumulationgrade was higher in layered plaque than in non-layered plaque (49.1%vs.33.3%, P=0.035). The incidence of TCFA was higher in layered plaque than in non-layered plaque (68.4%vs. 40.6%, P=0.002).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3116615/v1/a78e8009228916c5569b6d5e.png"},{"id":40539481,"identity":"53170c73-eb52-4a90-8122-13e7e3aa964c","added_by":"auto","created_at":"2023-07-25 13:56:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":38339,"visible":true,"origin":"","legend":"\u003cp\u003eClinical presentation and prevalence of layered plaque and non-layered plaque at the culprit lesion. More patients with UAP than AMI in comparison of prevalence of layered plaques (71.9%vs.28.1%,p＜0.001.) AMI acute myocardial infarction; UAP unstable angina pectoris.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3116615/v1/07d12f25676d3c7c3deb0341.png"},{"id":58045980,"identity":"ff873606-eac2-42d5-90cd-ea91e8a7bc64","added_by":"auto","created_at":"2024-06-10 11:41:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1433626,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3116615/v1/bb30c7e7-e416-448e-90bb-94026cb6498e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Layered plaques and coronary plaque vulnerability: an optical coherence tomography study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute coronary syndrome (ACS) is often caused by acute and severe thrombosis subsequent to plaque rupture or plaque erosion resulting in interrupted coronary blood flow[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].However, in the majority of coronary atherosclerotic plaque progression, the thrombotic lesion is silent and has no clinical presentation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].At this point the body may undergoes a repeated process of plaque repair[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].However, repeated plaque repair processes can increase coronary lumen narrowing and plaque loading, which represents plaque progression[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Optical coherence tomography (OCT) is an intracoronary imaging technique in which layered plaque as a plaque that is clearly demarcated from the underlying components, close to the luminal surface, and consists of non-homogeneous signals in different optical density layers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].Accordingly, layered plaques are a type of plaque in which previous plaque instability leads to repair, their presence often represents higher levels of inflammatory response and greater plaque vulnerability[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Previous studies have shown that layered plaques are a bridge between stable angina pectoris(SAP)and acute coronary syndromes, with a higher probability of subsequent major adverse cardiovascular events(MACE)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Identifying layered plaques can help in risk stratification for patients with high-risk plaque features[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In this study, we sought to explore the independent risk factors that predict layered plaque in patient with ACS based on OCT.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe statistics show that from a total of 165 patients with coronary heart disease (CHD) who underwent pre-intervention OCT examination between January 2020 and January 2023. For this analysis, 39 patients were excluded for in-stent thrombosis (n\u0026thinsp;=\u0026thinsp;12), stable angina pectoris(n\u0026thinsp;=\u0026thinsp;15),extreme age (n\u0026thinsp;=\u0026thinsp;2), the lack of preintervention OCT examinations (n\u0026thinsp;=\u0026thinsp;5), poor imaging quality mainly due to massive thrombus (n\u0026thinsp;=\u0026thinsp;5).Of these,126 patients were met inclusion criteria and were eligible for the study, the study flowchart is as shown in Fig.\u0026nbsp;1, and the diagnosis of ACS includes ST-segment elevation myocardial infarction(STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and Unstable angina (UA).The diagnostic criteria for ACS are based on previous guidelines[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Demographic features, clinical data, ACS risk factors, blood biochemical indicators, CAG and OCT results were evaluated. This study was approved by the Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University(K202306-05), all patients have signed an informed consent to participate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBlood tests\u003c/h2\u003e \u003cp\u003eAll patients had peripheral blood drawn 8 hours prior to CAG in the fasting state. All quantitative tests, including white blood cell count, neutrophil count, lymphocyte count, platelet count, fibrinogen, D-dimer, triglycerides, total cholesterol, LDL, HDL, etc. are performed by our Laboratory Department using a Fully Automated Blood Cell Analyzer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCoronary angiography analysis\u003c/h2\u003e \u003cp\u003eCoronary angiography for all patients within 24 hours of admission, CAG and percutaneous coronary intervention (PCI) are mainly performed using the Judkins method with a radial approach. And the Angiographic analysis were performed by two 2 experienced cardiovascular physicians on baseline coronary angiograms acquired during the index. The location of lesion, type of lesion, diameter stenosis, and culprit lesion length were measured. The culprit lesion in ACS was defined as a combination of coronary angiographic findings, electrocardiographic changes, and/or abnormal left ventricular wall motion, with evidence of fractional flow reserve for ischaemia. The culprit lesion was defined as the degree of stenosis on coronary angiogram or the site of PCI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOCT image acquisition and measurement\u003c/h2\u003e \u003cp\u003eOCT was performed using the commercially available C7-XR OCT intravascular imaging system (C7-XRTM OCT Intravascular Imaging System, St. Jude Medical, St. Paul, MN, USA). Pullback speed was 20mm/s, and the total pullback distance of the system was 50 mm. All OCT images were analyzed by two independent investigators. During off-line review, the investigators was blinded to the patient data. Layered plaque as a layered plaque with heterogeneous signal-rich layered tissue of different optical signal intensity that close to the luminal surface, clearly demarcated from the underlying plaque[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Layered plaques have the same characteristics as healed plaques on OCT, so the terms \u0026ldquo;layered plaques\u0026rdquo; and \u0026ldquo;healed plaques\u0026rdquo; can be used interchangeably. According to the present guide consensus for OCT [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e],Lipid plaque was defined as a diffusely bordered signal-poor region with an overlying signal rich band, and lipid arc was measured every 1 mm. Fibrous plaque was defined as a plaque with homogeneous, high back-scattering signal. Calcifications were defined as signal-poor or heterogeneous areas delimited by sharp borders. Thin-cap fibroatheroma (TCFA) was defined as plaque with Lipid content\u0026thinsp;\u0026ge;\u0026thinsp;two quadrants and the fibrous cap thickness\u0026thinsp;\u0026le;\u0026thinsp;65 \u0026micro;m. Plaque rupture was identified as intimal tearing, disruption, or dissection of the fibrous cap. Plaque erosion was defined by the presence of attached thrombus overlying an intact and visualized plaque or luminal surface irregularity at the culprit lesion in the absence of thrombus. Vasa vasorum appear as signal-poor voids that are sharply delineated and can usually be followed in multiple contiguous frames. Cholesterol crystals appear in OCT images as thin, linear regions of high intensity. Macrophage accumulation was defined as the presence of signal-rich, distinct, or confluent punctate regions and generate a backward shadowing[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Representative images of layered plaque and nonlayered plaque are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analysis was performed using business software (SPSS 24.0 IBM, New York, NY, USA). Normally distributed continuous data were expressed as means and standard deviations, and Student \u003cem\u003et\u003c/em\u003e test was used for comparison between groups; non-normally distributed continuous data were expressed as median M (P25, P75) and Mann-Whitney U test was used for comparison between groups; categorical data were expressed as frequencies and percentages (%), and were compared using χ\u003csup\u003e2\u003c/sup\u003e test or Fisher exact tests. To assess whether baseline characteristics and plaque characters had an impact on layered plaque, Significant variables in the univariable model were included in the multivariable logistic regression model. And multivariable logistic regression model was also used to adjust confounders and calculate odds ratios (OR) and 95% confidence intervals (CI). p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinally, Among 126 patients,57 (45.2%) patients had layered plaque at the culprit lesions, and the baseline patient characteristics based on the presence or absence of layered plaques between the two groups are summarized in Table 1.\u0026nbsp;Patients with layered plaque were higher statin uptake rate compared to those non-layered plaque (100%vs.89.9%,\u0026nbsp;P=0.037).\u0026nbsp;No significant differences in clinical presentation, CHD history or other baseline data were observed between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical biochemical indicators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable2 shows the Clinical biochemical indicators of the two groups. It is observed that patients with layered plaque has higher level Uric acid (368.613\u0026plusmn;91.840vs.327.901\u0026plusmn;76.232\u0026mu;mol/L, P=0.009) and Indirect bilirubin (9.873\u0026plusmn;5.252vs.8.130\u0026plusmn;4.039, P=0.037) compare to patient with non-layered plaque. No other laboratory variables were significantly different between two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAngiographic findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCAG findings of the included ACS patients according to the layered plaque are presented in Table 3.\u0026nbsp;Longer lesion length in the layered plaque group compared with the non-layered plaque group (10(8,12) vs.8(5.5,10.0), P=0.004).\u0026nbsp;There was no significant difference in other CAG findings between those two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOptical coherence tomography findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe optical coherence tomography analysis results are shown in Table 4.\u0026nbsp;The layered plaque group had a higher lipid index compared to the non-layered group (1400(631.5,2257) vs.1080(577.5,1455),\u0026nbsp;P=0.02)). Macrophage accumulation in the layered plaque group was higher compared to the non-layered plaque group (49.1%vs.33.3%, P=0.035).\u0026nbsp;The incidence of TCFA was higher in the layered plaque group than in the non-layered plaque group (68.4%vs. 40.6%,\u0026nbsp;P=0.002). OCT characteristics of layered plaque and non-layered plaque at the culprit lesion in\u0026nbsp;fig3. Moreover, no statistical difference was detected for OCT findings between those two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors for layered culprit plaque\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 shows the results of multivariable analysis. The following variables were included in the multivariable model: Diabetes mellitus, BMI, Uric acid, IBil.\u0026nbsp;In the multivariable model, Uric acid, Lesion length, TCFA were independent predictors for layered culprit plaque(all p＜0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of layered plaque in patients with ACS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of a layered plaque at the culprit lesion was compared among different clinical presentations in fig4. The prevalence of layered culprit plaque was significantly higher in patients with unstable angina pectoris.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study we demonstrated that layered plaques were associated with\u0026nbsp;plaque vulnerability.\u0026nbsp;Moreover, Uric acid was independently associated with coronary\u0026nbsp;layered plaques. These findings suggest that\u0026nbsp;Uric acid\u0026nbsp;may be used as inexpensive markers for risk stratification in ACS patients.\u003c/p\u003e\n\u003cp\u003eWith the development of intracoronary imaging techniques, the ability to identify vulnerable plaques has gradually improved, with the advantage of OCT being its higher resolution, as an in vivo diagnostic modality with excellent sensitivity and specificity for detecting\u0026nbsp;plaque morphology and vessel wall microstructure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe layered plaque consists mainly of proliferating smooth muscle cells forming loose type III collagen fibrils and proteoglycans, which then gradually transition to type I collagen fibrils and re-endothelialize. Histopathological layered plaques have a layered appearance on OCT views and are morphologically layered. The layered plaque reflects the repair process of previous plaque rupture and thrombus[15, 16], representing previous plaque instability. Plaque repair can cause further coronary lumen stenosis[17]. Layered plaques are generally observed in both SAP and ACS patients[18-20]. Previous studies have found that it is more common in patients with SAP. Because patients with stable angina have a greater weight of endogenous anti-thrombotic system, which is more resistant to thrombosis and prevents occlusive thrombus formation[21].\u0026nbsp;Our study found that layered plaques were mostly present in patients with unstable angina\u0026nbsp;(71.9%vs. 21.8%，p＜0.001), which may be associated with more repair processes after plaque rupture or thrombosis. what is more, behind the formation of layered plaque is a greater vulnerability to plaque and inflammatory response, as more macrophage infiltration and TCFA presence is observed around the layered plaque, the presence of layered plaque is not a protective factor and may even be a possible acute thrombotic event in patients with ACS. From this it is clear that identify layered plaque is useful for optimizing the treatment of coronary artery disease and improve clinical outcomes for patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and angiography data in layered plaque\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn an autopsy study, it was found that plaque ruptures were found in 61% of\u0026nbsp;acute myocardial infarction who died suddenly of cardiac shock\u0026nbsp;and were associated with layered plaque, silent plaque rupture is a form of wound healing that results in increased percent stenosis[22]. Mann and Davies reported that 73.2% of plaque types with luminal stenosis greater than 50% in ischaemic heart disease had layered plaques. Layered plaques also represent a higher degree of luminal stenosis and vulnerable plaque characteristics[23]. Our research also found\u0026nbsp;longer lesion length in the layered plaque group compared with the non-layered plaque group.\u0026nbsp;A retrospective observational study had discovered that higher lumen stenosis and lower stent expansion ratio and mean stent eccentricity index (SEI)when having layered plaque. Angiographically complex lesions (type B2/C) were more frequent in patients with layered culprit lesions[24]. In the present study, patients with stent implantation, there was a higher incidence of post-stenting failure and formation of in-stent atherosclerosis after stent expansion when possessing layered plaques[25]. Matsuo had also clarified layered plaques are positively correlated with lumen narrowing and plaque vulnerability[26]. An OCT and IVUS with iMap trial had shown that layered plaques were found in plaque rupture, suggesting that the risk of plaque rupture is higher when layered plaques are present. This shows that layered plaque can accelerate plaque progression[27]. Previous study finds hyperuricemia associated with plaque vulnerability, our research is consistent with this. Maybe associated with oxidative stress and endothelial damage caused by hyperuricemia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOCT data in layered plaque\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRusso discovered that patients with ACS had layered plaques \u0026ge; 30% in the non-culprit lesions.\u0026nbsp;And it was concluded that possession of layered plaques when composed of more macrophage infiltration, thinner fibrous cap, longer plaque length, longer lipid length and greater lipid index, further suggesting that having higher levels of inflammation when layered plaques are present\u0026nbsp;[28]. In addition, our results showed that 28.1% AMI patient have\u0026nbsp;layered plaques and layered plaques were associated with\u0026nbsp;plaque vulnerability. In a 3-Vessel OCT Study, it was found that ACS caused by plaque erosion, followed by the formation of layered plaques, the combination of layered plaques at the site of plaque erosion had smaller minimal lumen area and greater degree of luminal stenosis. Both the culprit and non-culprit lesions, patients with layered plaque at the culprit site had higher incidence of lipid plaque, microchannels, cholesterol crystals, calcification than those without. Layered plaque is more likely to lead to adverse cardiovascular events later in the process[29]. A recent OCT study has demonstrated that layered plaques were detected in 74.5% of patients with ACS, and associated with thin-cap fibroatheromas[30]. Russo et al had reported that combined a layered plaque at the culprit vessel, greater plaque vulnerability, higher prevalence of calcifications, heavier lipid plaque and greater macrophage infiltration in possession of the layered plaque, suggesting that layered plaques are associated with vulnerable plaques again[19]. An OCT study investigating layered plaque in non-culprit lesions（NCLs）show that NCLs with layered plaque had more lipid-rich plaque, macrophage accumulations, microvessels and spotty calcification compared to NCLs without layered plaque[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes with layered plaque\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAraki reported that\u0026nbsp;a new layer was detected in 25 of 41 plaques at follow-up in stable angina patient, and the presence of layered plaque is strongly associated with the occurrence of major adverse cardiovascular events after PCI,\u0026nbsp;identified layered plaque as predictors of subsequent rapid lesion progression.\u0026nbsp;but the exact mechanism is unclear[31]. In a large cohort study that included 726 non-culprit lesions which had undergone PCI, 21.9% of them were found to have layered plaques. Ischemia-driven revascularization (IDR) was found in up to 65 cases over a 2-year follow-up period. This leads to the conclusion that untreated layered plaque in PCI target vessel was present in 21.9% of patients and it was related to future non-culprit-related events[11]. the interaction of layered plaque with MACE still needs further study to clarify its specific mechanism.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are several limitations to this paper. First, this paper is a single-center retrospective study with a small sample size and average strength of argument, and larger clinical studies are needed to confirm the argument; second, only plaque characteristics of culprit vessels were included in this paper, and non-culprit vessels were not examined by OCT and therefore were not included in the study design and not all patients underwent 3-vessel OCT imaging.However, in clinical practice, OCT of 3 vessels is less commonly performed.Moreover it is sometimes difficult to distinguish layered plaques from other plaque components. However, in our study, there was greater interobserver agreement in the observation of layered plaques. Prognosis of patients not included, further research is needed on the correlation between layered plaques and long-term prognosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn patients with ACS, Uric acid was a predictor for layered plaques at culprit lesions. Layered plaques are prevalent and have more features of vulnerability and accelerated progression of atherosclerosis at culprit lesions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics committee of the First affiliated hospital of Xinjiang Medical University. All methods were performed in accordance with the relevant guidelines and regulations. Because of the retrospective design of the study, the need to obtain informed consent from eligible patients was waived by the ethics committee of the First affiliated hospital of Xinjiang Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the First Affiliated Hospital of Xinjiang Medical University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of\u0026nbsp;the First Affiliated Hospital of Xinjiang Medical University.\u0026nbsp;The permission to access and use the raw data was\u0026nbsp;obtained from\u0026nbsp;Zening Yu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a project grant from University Research Programme in Xinjiang Uygur Autonomous Region(XJEDU2021I015).\u0026nbsp;This study was supported by research grants from the First Affiliated Hospital of Xinjiang Medical University to Dr. Yang Yining. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceived and designed the study: YY and YZ. Data collection and analyzed the data: YZ. Quality control the study and revision:CQ,LX,YY. Wrote the paper: YZ. The manuscript was approved by all above authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePartida, R.A., et al., \u003cem\u003ePlaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes.\u003c/em\u003e Eur Heart J, 2018. \u003cstrong\u003e39\u003c/strong\u003e(22): p. 2070-2076.\u003c/li\u003e\n\u003cli\u003eFinn, A.V., et al., \u003cem\u003eConcept of vulnerable/unstable plaque.\u003c/em\u003e Arterioscler Thromb Vasc Biol, 2010. \u003cstrong\u003e30\u003c/strong\u003e(7): p. 1282-92.\u003c/li\u003e\n\u003cli\u003eVergallo, R. and F. 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Davies, \u003cem\u003eMechanisms of progression in native coronary artery disease: role of healed plaque disruption.\u003c/em\u003e Heart, 1999. \u003cstrong\u003e82\u003c/strong\u003e(3): p. 265-8.\u003c/li\u003e\n\u003cli\u003eKurihara, O., et al., \u003cem\u003eComparison of post-stent optical coherence tomography findings: Layered versus non-layered culprit lesions.\u003c/em\u003e Catheter Cardiovasc Interv, 2021. \u003cstrong\u003e97\u003c/strong\u003e(7): p. 1320-1328.\u003c/li\u003e\n\u003cli\u003eNakano, M., et al., \u003cem\u003eEx vivo assessment of vascular response to coronary stents by optical frequency domain imaging.\u003c/em\u003e JACC Cardiovasc Imaging, 2012. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 71-82.\u003c/li\u003e\n\u003cli\u003eMatsuo, Y., et al., \u003cem\u003eAssociation of Hemodynamic Severity With Plaque Vulnerability and Complexity of Coronary Artery Stenosis: A Combined Optical Coherence Tomography and Fractional Flow Reserve Study.\u003c/em\u003e JACC Cardiovasc Imaging, 2019. \u003cstrong\u003e12\u003c/strong\u003e(6): p. 1103-1105.\u003c/li\u003e\n\u003cli\u003eHougaard, M., et al., \u003cem\u003eUncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap.\u003c/em\u003e JACC Cardiovasc Imaging, 2018. \u003cstrong\u003e11\u003c/strong\u003e(6): p. 859-867.\u003c/li\u003e\n\u003cli\u003eRusso, M., et al., \u003cem\u003eCharacteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque.\u003c/em\u003e Eur Heart J Cardiovasc Imaging, 2020. \u003cstrong\u003e21\u003c/strong\u003e(12): p. 1421-1430.\u003c/li\u003e\n\u003cli\u003eYin, Y., et al., \u003cem\u003eCulprit and Non-Culprit Plaque Characteristics With vs. Without a Healed Phenotype in Patients With Acute Myocardial Infarction Caused by Plaque Erosion\u003c/em\u003e\u003cem\u003e \u003c/em\u003e\u003cem\u003e- A 3-Vessel OCT Study.\u003c/em\u003e Circ J, 2022. \u003cstrong\u003e86\u003c/strong\u003e(5): p. 846-854.\u003c/li\u003e\n\u003cli\u003eDai, J., et al., \u003cem\u003eFrequency, Predictors, Distribution, and Morphological Characteristics of Layered Culprit and Nonculprit Plaques of Patients With Acute Myocardial Infarction: In Vivo 3-Vessel Optical Coherence Tomography Study.\u003c/em\u003e Circ Cardiovasc Interv, 2020. \u003cstrong\u003e13\u003c/strong\u003e(10): p. e009125.\u003c/li\u003e\n\u003cli\u003eAraki, M., et al., \u003cem\u003ePredictors of Rapid Plaque Progression: An Optical Coherence Tomography Study.\u003c/em\u003e JACC Cardiovasc Imaging, 2021. \u003cstrong\u003e14\u003c/strong\u003e(8): p. 1628-1638.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable1 Baseline data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003eLayered plaque(n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003eNon-layered plaque(n=69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/𝜒\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e60.40\u0026plusmn;10.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e59.43\u0026plusmn;9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e48(84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e49(71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e3.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e38(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e44(63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e14(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e18(26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.845\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eCurrent smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e27(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e31(44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eCurrent drinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e21(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e16(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e2.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of CAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e12(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e16(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e26.37\u0026plusmn;2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e26.45\u0026plusmn;3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eClinical presentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e2.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eAMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e16(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e11(15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eUAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e41(71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e58(84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eMedications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eAspirin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e57(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e64(92.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e2.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eStatins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e57(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e62(89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e4.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026beta;-Blockers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e42(73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e51(73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e33(57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e39(56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.8372513562387%\" valign=\"top\"\u003e\n \u003cp\u003eCCB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.72151898734177%\" valign=\"top\"\u003e\n \u003cp\u003e27(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.349005424954793%\" valign=\"top\"\u003e\n \u003cp\u003e29(42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.455696202531644%\" valign=\"top\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.636528028933093%\" valign=\"top\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as n (%), or mean \u0026plusmn; SD;\u0026nbsp;CAD,\u0026nbsp;Coronary artery disease; BMI, body mass index; UAP, unstable angina pectoris; AMI, acute myocardial infarction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Biochemical indices\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003eLayered plaque(n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003eNon-layered plaque(n=69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/𝜒\u003csup\u003e2\u003c/sup\u003e/\u0026nbsp;\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eWBC count,\u0026nbsp;\u0026times;10\u003csup\u003e9\u003c/sup\u003eL\u003csup\u003e-1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e7.268\u0026plusmn;1.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e6.804\u0026plusmn;1.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e1.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eRBC count,\u0026nbsp;\u0026times;10\u003csup\u003e9\u003c/sup\u003eL\u003csup\u003e-1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e4.659\u0026plusmn;0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e4.633\u0026plusmn;0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003ePLT count,\u0026nbsp;\u0026times;10\u003csup\u003e9\u003c/sup\u003eL\u003csup\u003e-1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e235.370\u0026plusmn;50.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e229.960\u0026plusmn;53.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eNeutrophil count,\u0026nbsp;\u0026times;10\u003csup\u003e9\u003c/sup\u003eL\u003csup\u003e-1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e4.571\u0026plusmn;1.980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e4.325\u0026plusmn;1.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eLymphocyte count,\u0026nbsp;\u0026times;10\u003csup\u003e9\u003c/sup\u003eL\u003csup\u003e-1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e1.931\u0026plusmn;0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e1.910\u0026plusmn;0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eHGB, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e139.350\u0026plusmn;13.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e140.960\u0026plusmn;15.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eAlbumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e42.786\u0026plusmn;4.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e42.046\u0026plusmn;3.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e1.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eFibrinogen, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e0.750(0.425,2.280)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e0.820(0.460,2.370)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eD-dimer,\u0026nbsp;mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e88(54,151.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e95(56,159)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eCreatinine, \u0026mu;mol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e76.726\u0026plusmn;23.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e82.191\u0026plusmn;29.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eCarbamide, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e6.011\u0026plusmn;1.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e5.753\u0026plusmn;2.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eUric acid, \u0026mu;mol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e368.613\u0026plusmn;91.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e327.901\u0026plusmn;76.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e2.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eeGFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e95.064\u0026plusmn;19.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e95.179\u0026plusmn;17.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eTBil, mmol/L\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e14.205\u0026plusmn;5.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e12.863\u0026plusmn;4.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e1.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eDBil, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e0.300(0.3,2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e0.300(0.3,3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eIBil, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e9.873\u0026plusmn;5.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e8.130\u0026plusmn;4.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e2.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e26.60(18.970,33.225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e25.50(19.600,33.340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e26.09(18.950,40.110)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e28.06(12.170,39.245)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eTC, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e3.77\u0026plusmn;1.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e3.670\u0026plusmn;1.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eTG, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eLDL-C, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e2.219\u0026plusmn;0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e2.203\u0026plusmn;0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.49097472924188%\" valign=\"top\"\u003e\n \u003cp\u003eHDL-C, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.826714801444044%\" valign=\"top\"\u003e\n \u003cp\u003e1.009\u0026plusmn;0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.20216606498195%\" valign=\"top\"\u003e\n \u003cp\u003e0.920\u0026plusmn;0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e1.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.191335740072201%\" valign=\"top\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as n (%), or mean \u0026plusmn; SD; WBC, white blood cell; RBC, red blood cell; PLT,\u0026nbsp;Platelet; HGB, hemoglobin; TBil, total bilirubin; DBiL, direct bilirubin; IBiL, unconjugated bilirubin; ALT,\u0026nbsp;alanine aminotransferase; AST,\u0026nbsp;aspartate transaminase TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Angiographic findings\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003eLayered plaque(n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003eNon-layered plaque(n=69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/𝜒\u003csup\u003e2\u003c/sup\u003e/\u0026nbsp;Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eTarget vessel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e2.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eLAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e44(77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e50(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eLCX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e9(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e10(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eRCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e4(7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e9(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of vascular lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e32(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e36(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e12(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e17(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e13(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e16(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eLocation of target plaque\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e1.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eProximal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e39(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e52(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eMid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e15(26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e13(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eDistal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e3(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e4(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eDiameter stenosis, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e80(67.5,90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e80(60,90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.741410488245933%\" valign=\"top\"\u003e\n \u003cp\u003eLesion length，mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.24231464737794%\" valign=\"top\"\u003e\n \u003cp\u003e10(8,12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.806509945750452%\" valign=\"top\"\u003e\n \u003cp\u003e8(5.5,10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.934900542495479%\" valign=\"top\"\u003e\n \u003cp\u003e2.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.2748643761302%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as n (%), or mean \u0026plusmn; SD; LAD,\u0026nbsp;Left anterior descending artery; LCX,\u0026nbsp;left circumflex artery; RCA,\u0026nbsp;right coronary artery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 OCT findings\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003eLayered plaque(n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003eNon-layered plaque(n=69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/𝜒\u003csup\u003e2\u003c/sup\u003e/\u0026nbsp;Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eFCT, \u0026mu;m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e130(50,200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e120(60,200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eLipid arc, degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e148(108.5,209.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e135(88.5,179.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e1.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eLipid index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e1400(631.5,2257)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e1080(577.5,1455)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e2.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eMacrophage accumulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e8.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e16(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e36(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e28(49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e23(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e9(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e10(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e4(7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e1(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eCholesterol crystals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e30(52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e27(39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e2.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eVasa vasorum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e27(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e26(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e1.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eThrombus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e8(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e9(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eCalcified nodule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e10(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e5(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e3.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristic of plaque\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e2.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Lipid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e32(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e46(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Calcified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e9(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e5(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fibrotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e16(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e19(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eTCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e39(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e28(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e9.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eplaque rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e6(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e4(5.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eplaque\u0026nbsp;erosion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e2(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e7(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e1.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eMLA, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e1.77(1.30,2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e2.10(1.62,2.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e1.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.29475587703436%\" valign=\"top\"\u003e\n \u003cp\u003eNLA, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e7.78(6.32,8.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.78481012658228%\" valign=\"top\"\u003e\n \u003cp\u003e7.93(6.84,9.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.296564195298373%\" valign=\"top\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.839059674502712%\" valign=\"top\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are presented as n (%), or mean \u0026plusmn; SD;\u0026nbsp;OCT optical coherence tomography; FCT, fibrous cap thickness; TCFA,\u0026nbsp;thin-cap fibroatheroma; MLA,\u0026nbsp;minimal lumen area; NLA,\u0026nbsp;normal lumen area\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable5 multivariate logistic regression for layered plaque\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Multivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eUric acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1.006(1.001-1.011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eIBil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1.081(0.996-1.173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e2.601(0.404-2.173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.975(0.870-1.092)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOR, odds ratio; CI, confidence interval.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute coronary syndrome, Layered plaque, Healed plaque, Optical coherence tomography","lastPublishedDoi":"10.21203/rs.3.rs-3116615/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3116615/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLayered plaques are a subclinical sign of plaque rupture or erosion, with plaque vulnerability and can be detected by optical coherence tomography (OCT). The study designed to evaluate the prevalence, angiographic, OCT characteristics of layered plaques in patients with acute coronary syndrome (ACS).\u003c/p\u003e\u003ch2\u003eMethods and results\u003c/h2\u003e \u003cp\u003eConsecutive ACS patients with 126 coronary culprit lesions underwent coronary angiography (CAG) and pre-intervention optical coherence tomography examination in this study. Patients were divided into layered plaque group (n\u0026thinsp;=\u0026thinsp;57) and non-layered plaque group(n\u0026thinsp;=\u0026thinsp;69) based on OCT plaque morphology. Layered plaque is heterogeneous signal-rich layered tissue of different optical signal intensity that close to the luminal surface, clearly demarcated from the underlying components on OCT. Patients with layered plaque were higher statin uptake rate compared to patients with non-layered plaque(P\u0026thinsp;=\u0026thinsp;0.037). Uric acid (368.613\u0026thinsp;\u0026plusmn;\u0026thinsp;91.840vs.327.901\u0026thinsp;\u0026plusmn;\u0026thinsp;76.232\u0026micro;mol/L, P\u0026thinsp;=\u0026thinsp;0.009) and Indirect bilirubin (IBil) (9.873\u0026thinsp;\u0026plusmn;\u0026thinsp;5.252vs.8.130\u0026thinsp;\u0026plusmn;\u0026thinsp;4.039, P\u0026thinsp;=\u0026thinsp;0.037) level is higher in layered plaque group compare to patient with non-layered plaque. Longer lesion length in the layered plaque group compared with the non-layered plaque group (10(8,12) vs.8(5.5,10.0), P\u0026thinsp;=\u0026thinsp;0.004). Higher lipid index (1400(631.5,2257) vs.1080(577.5,1455), P\u0026thinsp;=\u0026thinsp;0.02)), Macrophage accumulation (49.1%vs.33.3%, P\u0026thinsp;=\u0026thinsp;0.035) and TCFA (68.4%vs. 40.6%, P\u0026thinsp;=\u0026thinsp;0.002) in the layered plaque group compared with the non-layered plaque group. Results of multivariate analyses showed that Uric acid was independent risk factors of layered plaque in our cohorts (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study demonstrate that layered plaques are associated with plaque vulnerability and progression of atherosclerosis at culprit lesions in patient with ACS.\u003c/p\u003e","manuscriptTitle":"Layered plaques and coronary plaque vulnerability: an optical coherence tomography study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-25 13:55:57","doi":"10.21203/rs.3.rs-3116615/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b02a950-bb17-46e5-9556-ebd9feb4c8cf","owner":[],"postedDate":"July 25th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-10T11:32:59+00:00","versionOfRecord":[],"versionCreatedAt":"2023-07-25 13:55:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3116615","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3116615","identity":"rs-3116615","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}