Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
Atherosclerosis. 2020 Sep;309:1-7. doi: 10.1016/j.atherosclerosis.2020.07.005. Epub 2020 Jul 29.
We sought to investigate the characteristics and prognostic impact of healed plaque (HP) detected by optical coherence tomography (OCT) in non-culprit segments in treated vessels.
OCT analysis included HP having a different optical intensity with clear demarcation from underlying plaque, thin-cap fibroatheroma (TCFA), and minimal lumen area. Non-culprit lesion (NCL) was defined as a plaque with >90° arc of disease (≥0.5 mm intimal thickness), length ≥2 mm, and location >5 mm from the stent edges. Major adverse cardiac event (MACE) included cardiac death, myocardial infarction (MI), or ischemia-driven revascularization (IDR).
We studied a total of 726 NCLs in 538 patients who underwent percutaneous coronary intervention with evaluable non-culprit segments by OCT. The prevalence of an HP was 17.8% (129/726) per lesion and 21.9% (118/538) per patient. At median follow-up of 2.2 years, there were 65 NCL-related MACE events, including 6 MIs and 65 IDRs of which 87.7% had a stable presentation. The presence of untreated HP was positively correlated with subsequent NCL-related MACE (hazard ratio [HR] 2.01, 95% confidence interval [CI], 1.20-3.37, p < 0.01). There were 16 IDRs with stable angina occurring at a specific OCT-imaged NCL where an untreated HP was positively associated with subsequent NCL-related MACE (HR 3.72, 95% CI 1.35-10.30, p = 0.01) along with TCFA (HR 10.0, 95% CI 3.20-31.40, p < 0.01) and minimal lumen area <3.5 mm (HR 7.42, 95% CI 2.07-26.60, p < 0.01).
An OCT-detected HP in an NCL is a marker for future (mostly) stable non-culprit-related MACE at both a patient- and lesion-level.
我们旨在研究经光学相干断层扫描（OCT）检测到的治疗血管中非罪犯段的愈合斑块（HP）的特征及其对预后的影响。
OCT 分析包括具有与底层斑块不同光学强度且边界清晰的 HP、薄帽纤维粥样斑块（TCFA）和最小管腔面积。非罪犯病变（NCL）定义为斑块的疾病弧度>90°（≥0.5mm 内膜厚度）、长度≥2mm、位置距支架边缘>5mm。主要不良心脏事件（MACE）包括心脏死亡、心肌梗死（MI）或缺血驱动的血运重建（IDR）。
我们共研究了 538 例接受经皮冠状动脉介入治疗的患者的 726 个 NCL，这些患者的非罪犯段可通过 OCT 进行评估。每个病变的 HP 患病率为 17.8%（129/726），每个患者的患病率为 21.9%（118/538）。在中位随访 2.2 年后，有 65 个与 NCL 相关的 MACE 事件，包括 6 例 MI 和 65 例 IDR，其中 87.7%的患者表现稳定。未治疗的 HP 的存在与随后的 NCL 相关的 MACE 呈正相关（危险比[HR] 2.01，95%置信区间[CI]，1.20-3.37，p<0.01）。在特定的 OCT 成像 NCL 中发生了 16 例稳定型心绞痛 IDR，未治疗的 HP 与随后的 NCL 相关的 MACE 呈正相关（HR 3.72，95%CI 1.35-10.30，p=0.01），同时与 TCFA（HR 10.0，95%CI 3.20-31.40，p<0.01）和最小管腔面积<3.5mm（HR 7.42，95%CI 2.07-26.60，p<0.01）有关。
在患者和病变水平，NCL 中 OCT 检测到的 HP 是未来（主要为稳定的）非罪犯相关 MACE 的标志物。
