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Clinical Significance of Coronary Healed Plaques in Stable Angina Pectoris Patients Undergoing Percutaneous Coronary
Shigeki Kimura1, Ami Isshiki1, Masato Shimizu1
1Department of Cardiology, Yokohama Minami Kyosai Hospital.
Insights
Healed plaques (HPs) in stable angina patients undergoing percutaneous coronary intervention (PCI) indicate more complex, vulnerable lesions. These findings suggest HPs are linked to poorer PCI outcomes and increased need for target lesion revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Optical Coherence Tomography
Background:
- Healed plaques (HPs) are associated with advanced atherosclerosis and potential for rapid progression.
- The clinical significance of HPs in stable angina pectoris (SAP) patients undergoing percutaneous coronary intervention (PCI) is not well understood.
Purpose of the Study:
- To investigate the characteristics and post-PCI outcomes of HPs compared to non-HPs in SAP patients.
- To determine if HPs are an independent predictor of adverse outcomes after PCI.
Main Methods:
- Analysis of 417 lesions from SAP patients using pre- and post-intervention optical coherence tomography (OCT).
- HPs defined by a layered appearance on OCT.
- Propensity score matching used to compare clinical and lesion characteristics and post-PCI outcomes between HPs and non-HPs.
Main Results:
- HPs were present in 51.8% of lesions.
- In propensity-matched cohorts, HPs showed higher rates of complex lesions (B2/C), lipid-rich plaques, macrophages, greater stenosis, and more irregular tissue protrusion post-stenting.
- Target lesion revascularization (TLR)-free survival was poorer in HPs, and HPs were an independent predictor of TLR.
Conclusions:
- HPs in SAP patients represent more complex and vulnerable coronary lesions.
- The presence of HPs is associated with worse outcomes following PCI, including a higher likelihood of TLR.
Background:
Coronary healed plaques (HPs) reportedly have high vulnerability or show advanced atherosclerosis and a risk of rapid plaque progression. However, the prognosis of stable angina pectoris (SAP) patients with HPs undergoing percutaneous coronary intervention (PCI) remains under-investigated.
Methods And Results:
We analyzed 417 consecutive lesions from SAP patients undergoing pre- and post-intervention optical coherence tomography (OCT) for which HPs were defined as having a layered appearance. We investigated the differences in clinical and lesion characteristics, and post-PCI outcomes between HPs and non-HPs. To account for differences in clinical characteristics, propensity score matching was performed between the groups. HPs were observed in 216 lesions (51.8%) in the total cohort. In the propensity-matched cohort (n=294), HPs had higher rates of angiographic-B2/C lesions (77.6% vs. 59.2%, P<0.001), OCT-lipid-rich plaques (40.8% vs. 25.9%, P=0.007), macrophages (78.2% vs. 44.2%, P<0.001), greater luminal area stenosis (73.5±11.0% vs. 71.5±10.3%, P=0.002), and a higher prevalence of post-stenting irregular tissue protrusion (45.1% vs. 14.7%, P<0.001) than non-HPs. In the total cohort, target lesion revascularization (TLR)-free survival was poorer for HPs (log-rank test 7.66; P=0.006), and Cox proportional hazards analysis showed HP as an independent predictor of TLR (hazard ratio, 5.98; 95% confidence interval, 1.72-20.82; P=0.005).
Conclusions:
In SAP patients, HPs had greater complexity of lesions and higher vulnerability, which may have contributed to the poorer post-PCI outcomes.