Sun Qianhui, Wang Shengfang, Zeng Ming, Liu Minghao, Zhao Chen, Yi Boling, Hu Sining, Yu Bo, Jia Haibo
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China (Q.S., S.W., M.Z., M.L., C.Z., B. Yi, S.H., B. Yu, H.J.).
Key Laboratory of Myocardial Ischemia, Harbin Medical University, Heilongjiang Province, China (Q.S., S.W., M.Z., M.L., C.Z., B. Yi, S.H., B. Yu, H.J.).
Circ Cardiovasc Imaging. 2025 Sep;18(9):e017915. doi: 10.1161/CIRCIMAGING.124.017915. Epub 2025 Aug 4.
Clonal hematopoiesis of indeterminate potential is a novel, nontraditional risk factor linked to coronary heart disease. and are the 2 most prevalent clonal hematopoiesis of indeterminate potential-associated driver genes. This study aims to evaluate their effects on plaque characteristics and prognosis in patients with ST-segment-elevation myocardial infarction.
Consecutive patients with ST-segment-elevation myocardial infarction (May 2017-May 2019) undergoing routine optical coherence tomography were enrolled. Targeted deep exome sequencing of peripheral blood (custom panel targeting and ) identified mutations (with a threshold variant allele frequency ≥2%). The primary end point was major adverse cardiovascular events, defined as a composite end point that includes all-cause death, nonfatal myocardial infarction, nonfatal stroke, and revascularization due to clinical ischemic events.
Among 628 patients, 12.3% were identified as carriers of or gene mutations. Patients with mutations were older (62.5 versus 55.6 years; <0.001), while the 2 groups showed comparable prevalence rates of hypertension (48.1% versus 43.2%), diabetes (22.1% versus 22.3%), and dyslipidemia (53.2% versus 61.7%). Carriers demonstrated greater plaque vulnerability characteristics on optical coherence tomography, including a higher macrophage proportion, smaller minimal lumen area, thinner fibrous cap, and higher lipid index. During a median follow-up of 2.4 years (interquartile range 2.0-3.0), major adverse cardiovascular events rates were significantly higher in the mutation group (39.5% versus 19.9%; <0.001). Both mutations (adjusted hazard ratio, 1.91 [95% CI, 1.19-3.07]; =0.008) and mutations specifically (adjusted hazard ratio, 3.57 [95% CI, 1.78-7.17]; <0.001) independently predicted major adverse cardiovascular events occurrence in patients with ST-segment-elevation myocardial infarction.
Patients with ST-segment-elevation myocardial infarction and mutations exhibit vulnerable characteristics in their coronary plaques, along with an increased risk of experiencing major adverse cardiovascular events. Moreover, carrying mutations confers a worse prognosis compared with solely having mutations.
