Lipid Plaque Burden in NSTE-ACS patients with or without COPD: insights from the SCAP trial

Background: COPD patients have higher recurrence of adverse events and worse prognosis after acute coronary syndrome (ACS). The underlying pathophysiological mechanism is not fully elucidated. Methods: In screening for COPD in ACS (SCAP) trial (NCT02324660), ACS patients with smoking habit underwent a predischarge screening procedure to detect undiagnosed chronic obstructive pulmonary disease (UCOPD) confirmed with spirometry at 60 days. Patients were then categorized as UCOPD or no-COPD. In 65 NSTE-ACS patients, we performed near infrared spectroscopy (NIRS) in the culprit and at least one non-culprit vessel (151 vessels overall), and we calculated the SYNTAX I score. Primary endpoint was max lipid core burden index (LCBI) 4 mm. Secondary endpoints were SYNTAX score I and vessel LCBI. Results: Max LCBI 4 mm and vessel LCBI were significantly higher in the UCOPD compared to the no-COPD group (UCOPD 388±122, no-COPD 264±131, p <0.001; UCOPD 118±50, no-COPD 82±42, p<0.001, respectively). UCOPD patients showed higher max LCBI 4 mm and LCBI vessel both in culprit and non-culprit vessels. SYNTAX score I was comparable between the two groups (UCOPD: 13.5 [5.5-24], no-COPD: 12.5 [5-24.5], p=0.7). Conclusions: NSTE-ACS patients with UCOPD showed a higher LCBI compared to those without COPD, while SYNTAX score I was comparable between the two groups.