Relationship between pancoronary inflammation and clinical outcome: a 3-vessel OCT study

The risk of recurrent cardiovascular events remains high in acute myocardial infarction (AMI) patients even after revascularization. Coronary residual inflammation plays a promoting role in this process. This study aimed to address the clinical impact of pancoronary inflammation at long-term follow-up in AMI patients.

Between January 2017 and December 2021, 1312 AMI patients underwent three-vessel optical coherence tomography (OCT) imaging following successful percutaneous coronary intervention. Patients were stratified by the median number (3) of inflammatory plaques (defined as macrophage-containing non-culprit lesions) into low-inflammation (≤3 lesions) and high-inflammation (>3 lesions) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac mortality, non-fatal MI, and unplanned revascularization, assessed over a 5-year follow-up period.

The number of inflammatory plaques (i.e. pancoronary inflammation) had a significant correlation with hs-CRP level (i.e. systemic inflammation) (r = 0.109; P < 0.001). OCT features of plaque vulnerability were significantly more common in patients with high pancoronary inflammation level, compared to those with low pancoronary inflammation level. During a median 4.1-year follow-up, non-culprit lesion-related MACEs occurred more frequently in patients with more inflammatory plaques (8.1% versus 3.1% [hazard ratio, 2.71 (95% CI, 1.52-4.84)]), primarily attributable to increased risk of unplanned coronary revascularization. In multivariable models, higher pancoronary inflammation, rather than higher systemic inflammation, was the independent predictor of non-culprit lesion-related MACEs.

The high pancoronary inflammation was found to be associated with more vulnerable plaque characteristics and increased risk of long-term adverse cardiovascular events in AMI patients.