The role of high-risk plaque in refining cardiovascular event prediction

Area of Science:

• Cardiology
• Vascular Biology
• Medical Imaging

Background:

• High-risk plaque (HRP) features are prevalent in acute coronary syndromes (ACS) but have limited individual predictive value.
• Current risk stratification relies on limited assessment of HRP features.

Purpose of the Study:

• To review the integration of anatomical and physiological assessments for enhanced risk stratification in ACS.
• To explore optimizing therapeutic decision-making by combining HRP evaluation with hemodynamic data.

Main Methods:

• Review of studies evaluating HRP features and hemodynamic assessments.
• Analysis of plaque characteristics, inflammatory biomarkers, and hemodynamic stress.
• Synthesis of evidence on combined prognostic accuracy and revascularization guidance.

Main Results:

• Combining HRP evaluation with hemodynamic assessment significantly improves prognostic accuracy.
• Positive remodeling is associated with lesion-specific inflammation.
• Hemodynamic stress influences plaque progression and disruption.

Conclusions:

• A refined strategy integrating plaque burden, functional significance, and vascular inflammation enhances cardiovascular risk prediction.
• Optimizing preventive interventions and mitigating atherosclerosis progression can improve patient outcomes through integrated HRP assessment.