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