Is Imaging of a Single Vessel Sufficient to Assess Pan-Coronary Vulnerability?

Coronary atherosclerosis is a pan-coronary process. However, some studies investigated only one coronary artery and extrapolated the findings to the pan-vascular process.

We utilized a three-vessel optical coherence tomography (OCT) database to investigate whether plaque features in the left anterior descending coronary artery (LAD) mirror vulnerability in the remaining coronary vessels.

We analyzed 131 patients who underwent OCT imaging of the LAD, left circumflex (LCx), and right coronary artery (RCA). Vulnerable features, including thin-cap fibroatheroma (TCFA), lipid-rich plaque, macrophages, microvessels, and cholesterol crystals, were evaluated in each vessel. Vulnerable features in the LAD and non-LAD vessels were correlated at patient and plaque levels.

At the patient level, vulnerable features in the LAD correlated with those in non-LAD vessels (TCFA p < 0.001; lipid-rich plaque p < 0.001; macrophages p = 0.010; microvessels p = 0.012; cholesterol crystals p = 0.045). However, an LAD-only strategy would have missed 30%-75% of patients with vulnerable features in non-LAD vessels; the adjusted miss rates were 58.7% for TCFA, 28.2% for lipid-rich plaque, 44.3% for macrophages, 36.9% for microvessels, and 75.7% for cholesterol crystals. At the plaque level, a similar number of high-risk plaques in non-LAD arteries would have been overlooked by the LAD-only approach, with the adjusted miss rates ranging from 74.3% for cholesterol crystals to 26.7% for lipid-rich plaque.

Vulnerable plaque features in the LAD were associated with their presence in the other coronary arteries. However, a single-vessel LAD assessment would have missed a substantial proportion of patients with vulnerable features in the LCx or RCA.