High-risk plaques in non-culprit lesions and clinical outcome after NSTEMI vs. STEMI
Rick H J A Volleberg1, Jan-Quinten Mol1, Anouar Belkacemi2
1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
High-risk plaque in non-culprit lesions is similar in non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) patients, leading to more cardiovascular events in both groups. Further research on complete revascularization for NSTEMI is warranted.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Imaging
Background:
- Complete non-culprit (NC) revascularization may reduce recurrent events after non-ST-segment elevation myocardial infarction (NSTEMI).
- High-risk plaque (HRP) features in NC lesions may influence outcomes similarly in NSTEMI and ST-segment elevation myocardial infarction (STEMI).
- Clinical Trial Registration: NCT03857971.
Purpose of the Study:
- To compare plaque morphology in FFR-negative NC lesions between NSTEMI and STEMI patients using optical coherence tomography (OCT).
- To assess the association between HRP morphology and major adverse cardiovascular events (MACE) in NSTEMI and STEMI.
- To evaluate the impact of NC HRP on clinical outcomes in myocardial infarction (MI) patients.
Main Methods:
- Prospective observational study (PECTUS-obs) involving 438 MI patients.
- OCT imaging of FFR-negative intermediate NC lesions.
- Two-year follow-up for MACE (all-cause mortality, non-fatal MI, unplanned revascularization).
Main Results:
- Prevalence of HRPs (thin-cap fibroatheromas, plaque rupture, thrombus) was comparable between 203 NSTEMI and 217 STEMI patients.
- MACE occurred in 14.3% of NSTEMI and 7.4% of STEMI patients (Puni-variable = 0.025).
- HRP presence was numerically associated with higher MACE rates in both groups; plaque rupture specifically predicted MACE in both NSTEMI and STEMI.
Conclusions:
- High-risk plaque in non-culprit lesions is similarly prevalent in NSTEMI and STEMI.
- The presence of NC HRP is associated with numerically higher event rates in both MI types.
- Further investigation into complete revascularization strategies for NSTEMI and HRP treatment is recommended.
Aims:
Complete non-culprit (NC) revascularisation may help reduce recurrent events after non-ST-segment elevation myocardial infarction (NSTEMI), especially if NC lesions would harbour high-risk plaque (HRP) features similar to ST-segment elevation myocardial infarction (STEMI). This study aimed to assess differences in fractional flow reserve (FFR)-negative NC plaque morphology in patients presenting with NSTEMI vs. STEMI and assess the association of HRP morphology and clinical outcome.
Methods And Results:
In the prospective PECTUS-obs study, 438 patients presenting with myocardial infarction (MI) underwent optical coherence tomography (OCT) of all FFR-negative intermediate NC lesions. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE, composite of all-cause mortality, non-fatal MI or unplanned revascularisation) at 2-year follow-up. Four hundred and twenty patients had at least one analysable OCT, including 203 (48.3%) with NSTEMI and 217 (51.7%) with STEMI. The prevalence of HRPs, including thin-cap fibroatheromas, plaque rupture, and thrombus, was comparable between groups. MACE occurred in 29 (14.3%) NSTEMI patients and 16 (7.4%) STEMI patients (Puni-variable = 0.025 and Pmulti-variable = 0.270). Incidence of MACE was numerically higher among patients with HRP, irrespective of the clinical presentation at index (Pinteraction = 0.684). Among HRP criteria, plaque rupture was associated with MACE in both NSTEMI (P < 0.001) and STEMI (P = 0.020).
Conclusion:
Presence of NC HRP is comparable between NSTEMI and STEMI and leads to numerically higher event rates in both. These results call for additional research on complete revascularisation in NSTEMI and treatment of HRP.
Clinical Trial Registration:
NCT03857971.
More Related Videos
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...