Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Biology

Background:

• Obstructive coronary plaques may exhibit more vulnerable characteristics than nonobstructive lesions.
• Understanding plaque vulnerability in nonculprit lesions is crucial for managing coronary artery disease.

Purpose of the Study:

• To assess the association between pressure-wire-based physiologic indices and vulnerable plaque characteristics in nonculprit coronary lesions.
• To investigate plaque features in intermediate lesions of patients with recent myocardial infarction.

Main Methods:

• The PROSPECT II study enrolled patients with recent myocardial infarction.
• Coronary angiography, intravascular ultrasound, near-infrared spectroscopy, and fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) were used.
• Assessment included all three coronary arteries, focusing on intermediate lesions (>40% stenosis).

Main Results:

• Physiologically significant lesions (FFR ≤0.80 or iFR ≤0.89) were more likely to have small minimal lumen area, high plaque burden, and high lipid core burden index.
• Left anterior descending artery location, small minimal lumen area, and large plaque burden were independently associated with physiologic significance.
• Maximum lipid core burden index was not independently associated with physiologic significance.

Conclusions:

• Angiographically intermediate but physiologically significant coronary lesions in myocardial infarction patients frequently display high-risk vulnerable plaque features.
• Non-significant coronary lesions also exhibit a notable prevalence of high-risk plaque characteristics.
• These findings may explain the residual risk observed with conservative management of non-significant lesions.