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Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography

      Highlights

      • Untreated healed plaque in PCI target vessel was present in 22% of patients.
      • Untreated healed plaque was related to future non-culprit-related events.
      • Untreated healed plaque could be a marker of atherosclerotic lesion progression.

      Abstract

      Background and Aims

      We sought to investigate the characteristics and prognostic impact of healed plaque (HP) detected by optical coherence tomography (OCT) in non-culprit segments in treated vessels.

      Methods

      OCT analysis included HP having a different optical intensity with clear demarcation from underlying plaque, thin-cap fibroatheroma (TCFA), and minimal lumen area. Non-culprit lesion (NCL) was defined as a plaque with >90° arc of disease (≥0.5 mm intimal thickness), length ≥2 mm, and location >5 mm from the stent edges. Major adverse cardiac event (MACE) included cardiac death, myocardial infarction (MI), or ischemia-driven revascularization (IDR).

      Results

      We studied a total of 726 NCLs in 538 patients who underwent percutaneous coronary intervention with evaluable non-culprit segments by OCT. The prevalence of an HP was 17.8% (129/726) per lesion and 21.9% (118/538) per patient. At median follow-up of 2.2 years, there were 65 NCL-related MACE events, including 6 MIs and 65 IDRs of which 87.7% had a stable presentation. The presence of untreated HP was positively correlated with subsequent NCL-related MACE (hazard ratio [HR] 2.01, 95% confidence interval [CI], 1.20–3.37, p < 0.01). There were 16 IDRs with stable angina occurring at a specific OCT-imaged NCL where an untreated HP was positively associated with subsequent NCL-related MACE (HR 3.72, 95% CI 1.35–10.30, p = 0.01) along with TCFA (HR 10.0, 95% CI 3.20–31.40, p < 0.01) and minimal lumen area <3.5 mm2 (HR 7.42, 95% CI 2.07–26.60, p < 0.01).

      Conclusions

      An OCT-detected HP in an NCL is a marker for future (mostly) stable non-culprit-related MACE at both a patient- and lesion-level.

      Graphical abstract

      Keywords

      Abbreviations:

      ACS (acute coronary syndrome), CAD (coronary artery disease), HP (healed plaque), IDR (ischemia-driven revascularization), MI (myocardial infarction), MLA (minimal lumen area), NCL (non-culprit lesion), MACE (major adverse cardiac event), OCT (optical coherence tomography), PCI (percutaneous coronary intervention), TCFA (thin-cap fibroatheroma)
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