Predictors of Rapid Plaque Progression: An Optical Coherence Tomography Study

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Pathology

Background:

• Arterial plaque progression occurs via slow linear or rapid step-wise patterns.
• Rapid progression is associated with acute coronary syndromes and sudden cardiac death.
• Identifying predictors of rapid plaque progression is crucial for risk stratification.

Purpose of the Study:

• To identify morphological predictors of rapid plaque progression using optical coherence tomography (OCT).
• To evaluate baseline plaque characteristics associated with rapid lesion progression.
• To assess morphological changes in rapidly progressing plaques over time.

Main Methods:

• Patients with non-culprit lesions (stenosis ≥30%) undergoing OCT and follow-up angiography (≥6 months) were selected.
• Lesion progression defined as ≥0.4 mm decrease in lumen diameter at follow-up.
• Baseline and follow-up OCT imaging analyzed for morphological features.

Main Results:

• Fifty of 517 lesions showed rapid progression.
• Rapidly progressing lesions had higher prevalence of lipid-rich plaque, TCFA, layered plaque, macrophage accumulation, microvessels, rupture, and thrombus.
• Multivariate analysis identified lipid-rich plaque (OR 2.17), TCFA (OR 5.85), and layered plaque (OR 2.19) as significant predictors.

Conclusions:

• Lipid-rich plaques, TCFA, and layered plaques are key predictors of rapid plaque progression.
• A new intraluminal layer, indicating plaque disruption and healing, was observed in over half of rapidly progressing lesions at follow-up.
• These OCT-derived morphological features can improve risk assessment for adverse cardiovascular events.