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Published on: January 28, 2020
Change of multiple complex coronary plaques in patients with acute myocardial infarction: a study with coronary
Sang-Gon Lee1, Cheol Whan Lee, Myeong-Ki Hong
1Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Insights
In patients with acute myocardial infarction (AMI), non-culprit complex coronary plaques largely remained unchanged over six months. However, multiple complex plaques were associated with a higher risk of long-term cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Patients with acute myocardial infarction (AMI) often present with multiple complex coronary plaques beyond the primary culprit lesion.
- The natural history and progression of these non-culprit complex plaques remain poorly understood.
- Understanding plaque behavior is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate the natural history of non-culprit complex coronary plaques in patients hospitalized for AMI.
- To assess changes in plaque severity and morphology over a follow-up period.
- To correlate the presence of multiple complex plaques with long-term cardiac events.
Main Methods:
- Coronary angiography was performed on 229 patients with AMI undergoing primary angioplasty.
- Baseline and follow-up angiographic data (mean follow-up 192 days) were compared for patients with multiple complex plaques.
- Complex plaques were defined by characteristics like thrombus, ulceration, and irregular morphology.
Main Results:
- Of 62 patients with multiple complex plaques, 35 non-culprit complex lesions were analyzed.
- 82% of non-culprit complex lesions remained morphologically complex, with minimal change in stenosis severity (74% vs 72%).
- Patients with multiple complex plaques had a significantly higher incidence of long-term cardiac events (24% vs 10%).
Conclusions:
- Non-culprit complex coronary plaques exhibit limited angiographic change within a 6-month follow-up period after AMI.
- Despite stability, multiple complex plaques are linked to an increased risk of adverse cardiac events post-discharge.
- Further research is needed to optimize management strategies for these high-risk lesions.
Background:
Patients with acute myocardial infarction (AMI) may have multiple complex coronary plaques that are not limited to the culprit lesions. However, it is unknown whether they tend to progress in severity, regress, or remain stable. The aim of this angiographic study is to evaluate the natural history of these lesions.
Methods:
We consecutively enrolled 229 patients who underwent coronary angiography at the time of their hospitalization to treat AMI with primary angioplasty. Baseline and follow-up (mean follow-up duration, 192 +/- 33 days) coronary angiographic data in patients with multiple complex coronary plaques characterized by thrombus, ulceration, plaque irregularity, and impaired flow were compared.
Results:
Single complex coronary plaques were identified in 167 patients (73%), and multiple complex plaques were identified in the other 62 patients (27%). Among the patients with multiple complex plaques (62 patients, 83 non-culprit complex plaques), the angiographic examinations were reviewed simultaneously in 43.5% (27 patients, 35 non-culprit complex plaques). Of 35 non-culprit complex lesions, 29 lesions (82%) remained complex without changing into smooth lesions, 1 lesion became totally occluded, and 4 lesions regressed. The severity of non-culprit complex lesions between baseline and follow-up angiography is equal (maximal diameter stenosis, 74% +/- 15% vs 72% +/- 15%, P =.4). Long-term cardiac events after discharge were more likely to develop in patients with multiple complex plaques than in patients with single complex plaques (24% vs 10%, respectively; P <.01).
Conclusions:
In patients with AMI, little angiographic change occurred during 6 months of follow-up in the non-culprit complex plaques.
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