Plaque Characteristics Derived from Intravascular Optical Coherence Tomography That Predict Cardiovascular Death

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Biomarkers of Atherosclerosis

Background:

• Cardiovascular (CV) death remains a significant concern following percutaneous coronary intervention (PCI).
• Accurate prediction of long-term CV risk is crucial for guiding therapeutic strategies.
• Intravascular optical coherence tomography (IVOCT) provides high-resolution imaging of coronary plaques.

Purpose of the Study:

• To determine if plaque characteristics identified by IVOCT can predict long-term CV death.
• To evaluate the utility of specific plaque features, including vulnerable plaque indicators, in risk stratification.
• To assess the discriminatory power of 3D plaque analysis for predicting adverse cardiovascular events.

Main Methods:

• Retrospective analysis of IVOCT images from 104 patients undergoing IVOCT-guided PCI.
• Plaque characterization using Optical Coherence TOmography PlaqUe and Stent (OCTOPUS) software, analyzing 31 features.
• Univariate and multivariate logistic regression analyses to identify predictors of CV death.

Main Results:

• CV death occurred in 23.1% of patients.
• Univariate analysis showed lesion length, calcium, and fibrous cap (FC) features were associated with CV death (p < 0.05).
• Multivariate analysis identified FC surface area as a significant predictor of CV death (OR 2.38, p < 0.05) with an AUC of 0.851.

Conclusions:

• Large fibrous cap surface area on baseline IVOCT images is a significant determinant of long-term CV death.
• 3D plaque analysis using IVOCT offers valuable insights into predicting cardiovascular outcomes.
• These findings may inform future recommendations for pharmaceutical and interventional approaches in high-risk patients.