Nonculprit Vulnerable Plaques and Prognosis in Myocardial Infarction With Versus Without ST-Segment Elevation: A
Pernille G Thrane1,2, Michael Maeng1,2, Akiko Maehara3,4
1Department of Cardiology, Aarhus University Hospital, Denmark (P.G.T., M. Maeng, H.E.B.).
Circulation
|June 23, 2025
Summary
High-risk plaques were similarly prevalent in ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients. Outcomes from untreated nonculprit lesions were also comparable, suggesting similar revascularization strategies for both patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Clinical guidelines differ on revascularization for nonculprit lesions in ST-elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI).
- The prevalence of high-risk vulnerable plaques and their impact on outcomes in STEMI versus NSTEMI is not well understood.
Purpose of the Study:
- To compare the prevalence of untreated high-risk vulnerable plaques in nonculprit lesions between STEMI and NSTEMI patients.
- To evaluate the long-term outcomes associated with these nonculprit lesions in both patient groups.
Main Methods:
- The PROSPECT II study enrolled 898 patients with recent myocardial infarction undergoing 3-vessel angiography.
- Near-infrared spectroscopy and intravascular ultrasound identified two-feature high-risk plaques (plaque burden ≥70% and lipid core burden index ≥324.7).
- Major adverse cardiovascular events (MACE) from untreated nonculprit lesions were tracked for a median of 3.7 years.
Main Results:
- The prevalence of two-feature high-risk plaques at the lesion level was slightly higher in STEMI (12.8%) vs. NSTEMI (10.1%), but similar at the patient level (38.8% vs. 32.7%).
- Prevalence of plaques meeting at least one high-risk criterion was also similar between STEMI and NSTEMI groups.
- Four-year rates of nonculprit lesion-related MACE (8.6% vs. 7.8%) and all MACE (14.2% vs. 13.0%) were comparable between STEMI and NSTEMI patients.
Conclusions:
- The per-patient prevalence of high-risk vulnerable plaques is comparable in STEMI and NSTEMI.
- Long-term incidence of major adverse cardiovascular events arising from nonculprit lesions is similar in both STEMI and NSTEMI.
- These findings support a similar revascularization strategy for nonculprit lesions in STEMI and NSTEMI patients post-culprit lesion management.
Keywords:
ST elevation myocardial infarctioncoronary artery diseasenon-ST elevation myocardial infarctionspectroscopy, near-infraredMore Related Videos
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