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Long-term clinical outcomes of high-risk plaques with negative fractional flow reserve: the PECTUS-obs study
Rick H J A Volleberg1, Jan-Quinten Mol1, Geert A A Versteeg1
1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
High-risk plaques (HRP) in non-culprit lesions increase major adverse cardiovascular events (MACE) long-term after myocardial infarction (MI). This risk appears concentrated in the initial two years post-MI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- High-risk plaques (HRP) in non-flow limiting, deferred non-culprit lesions are linked to adverse short-term outcomes post-myocardial infarction (MI).
- The long-term prognostic significance of these HRPs remains under-investigated.
Purpose of the Study:
- To assess the long-term association between the presence of HRP in non-culprit lesions and clinical outcomes following MI.
- To determine the prognostic value of HRP in patients undergoing evaluation after MI.
Main Methods:
- Prospective, observational PECTUS-obs study involving 438 patients with recent MI.
- Optical coherence tomography (OCT) used for analyzing fractional flow reserve-negative non-culprit lesions.
- Patients categorized based on the presence or absence of OCT-identified HRP; long-term outcomes evaluated.
Main Results:
- A median follow-up of 1828 days revealed that at least one HRP was associated with increased MACE (HR 1.87).
- Non-fatal MI (HR 4.07) and unplanned revascularization (HR 1.97) were significantly more frequent in patients with HRP.
- Exploratory analysis indicated the HRP-associated risk was primarily within the first two years post-MI.
Conclusions:
- Non-flow limiting HRPs in non-culprit lesions are associated with adverse patient-level clinical outcomes during long-term follow-up after MI.
- The prognostic impact of HRP may be more pronounced in the short term, specifically within the first two years.
Background:
High-risk plaques (HRP) in non-flow-limiting, deferred non-culprit lesions have been associated with adverse short-term cardiovascular outcomes after myocardial infarction (MI). However, the long-term prognostic implications remain largely unknown.
Aims:
This study sought to evaluate the long-term association between HRP and clinical outcome after MI Methods: In the prospective, observational PECTUS-obs study, 438 patients with recent MI underwent optical coherence tomography (OCT) of all fractional flow reserve-negative non-culprit lesions. Patients were grouped according to the presence or absence of at least one OCT-identified HRP. The current study evaluates the final long-term outcome. The primary patient-level endpoint was defined as major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal MI, or unplanned revascularisation, excluding all periprocedural, indeterminate, and stent failure-related events.
Results:
After a median follow-up of 1,828 days (interquartile range [IQR] 1,821-1,842), the presence of at least one HRP was associated with MACE (hazard ratio [HR] 1.87, 95% confidence interval [CI]: 1.11-3.14; p=0.017). Among the individual endpoint components, non-fatal MI (HR 4.07, 95% CI: 1.23-13.52; p=0.013) and unplanned revascularisation (HR 1.97, 95% CI: 1.07-3.64; p=0.027) occurred more frequently in patients with at least one HRP. In an exploratory landmark analysis, the risk associated with presence of HRP was observed only during the first 2 years of follow-up. The lesion-level incidence of target lesion failure did not differ significantly between groups (HR 1.65, 95% CI: 0.91-2.96; p=0.097).
Conclusions:
Non-flow-limiting, high-risk non-culprit plaques are associated with adverse patient-level clinical outcomes during long-term follow-up after MI, potentially with a more pronounced short-term risk.
Clinicaltrials:
gov: NCT03857971.
