Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial Infarction: A Prospect II Substudy.

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2025-02-24 DOI:10.1016/j.jcmg.2024.11.002

Ketina Arslani, Thomas Engstrøm, Michael Maeng, Lars Kjøller-Hansen, Akiko Maehara, Zhipeng Zhou, Ori Ben-Yehuda, Hans Erik Bøtker, Mitsuaki Matsumura, Gary S Mintz, Ole Fröbert, Jonas Persson, Rune Wiseth, Alf I Larsen, Lisette O Jensen, Jan E Nordrehaug, Øyvind Bleie, Elmir Omerovic, Claes Held, Stefan K James, Ziad A Ali, David Erlinge, Gregg W Stone

{"title":"Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial Infarction: A Prospect II Substudy.","authors":"Ketina Arslani, Thomas Engstrøm, Michael Maeng, Lars Kjøller-Hansen, Akiko Maehara, Zhipeng Zhou, Ori Ben-Yehuda, Hans Erik Bøtker, Mitsuaki Matsumura, Gary S Mintz, Ole Fröbert, Jonas Persson, Rune Wiseth, Alf I Larsen, Lisette O Jensen, Jan E Nordrehaug, Øyvind Bleie, Elmir Omerovic, Claes Held, Stefan K James, Ziad A Ali, David Erlinge, Gregg W Stone","doi":"10.1016/j.jcmg.2024.11.002","DOIUrl":null,"url":null,"abstract":"Background: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions.Objectives: The authors aimed to assess whether pressure-wire-based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics.Methods: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%.Results: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm2 (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not.Conclusions: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II [PROSPECT II]; NCT02171065).","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8000,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jcmg.2024.11.002","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions.

Objectives: The authors aimed to assess whether pressure-wire-based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics.

Methods: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%.

Results: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm² (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not.

Conclusions: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II [PROSPECT II]; NCT02171065).

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.