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Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial
Ketina Arslani1, Thomas Engstrøm2, Michael Maeng3
1Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, University Hospital Basel, Switzerland.
Insights
Physiologically significant coronary lesions in myocardial infarction patients show more vulnerable plaque features. However, even non-significant lesions can harbor high-risk characteristics, explaining residual risk.
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.
Background:
Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions.
Objectives:
The authors aimed to assess whether pressure-wire-based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics.
Methods:
In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%.
Results:
Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm2 (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not.
Conclusions:
In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II [PROSPECT II]; NCT02171065).
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