Long-term prognostic value of optical coherence tomography-identified non-culprit plaque rupture

Background Subclinical plaque rupture (i.e. non-culprit plaque rupture) was thought to be a sign of pancoronary vulnerability. Patients with non-culprit plaque rupture tended to have worse short-term outcome. The role of non-culprit plaque rupture on long-term clinical outcome remains undefined. Purpose This study aimed to observe the role of non-culprit plaque rupture in predicting the long-term recurrent adverse cardiac events in acute myocardial infarction (AMI) population. Methods From January 2017 and December 2021, patients presenting with AMI who underwent 3-vessel optical coherence tomography (OCT) before interventional therapy were studied. Patients and lesions were classified according to the presence or absence of OCT-identified plaque rupture at the non-culprit sites. In the sub-analysis, patients and lesions were further divided based on plaque rupture and/or non-ruptured thin-cap fibroatheroma (TCFA) at the non-culprit segments. Non-ruptured TCFA was defined as a lesion with TCFA but not a plaque rupture. All enrolled patients were followed for up to five years. Major adverse cardiac events (MACE) consisted of cardiac death, non-fatal myocardial infarction, and unplanned ischemia-driven revascularization. Results A total of 1312 AMI patients with 5273 non-culprit lesions were included in this study. Non-culprit plaque rupture was detected in 226 patients and 282 lesions. During a median 4.1year follow-up, non-culprit lesion-related MACEs occurred more frequently in patients with versus without plaque rupture, primarily attributable to increased risk of non-fatal MI and unplanned revascularization. However, non-culprit lesion-related MACEs was similar for lesions with versus without plaque rupture. In multivariable models, non-culprit plaque rupture was associated with non-culprit lesion-related MACEs at the patient level, but not at the lesion level. In the sub-analysis, non-ruptured TCFA was identified in 319 patients and 428 lesions. Non-ruptured TCFA was associated with non-culprit lesion-related MACEs but not plaque rupture, both at the patient and lesion levels in multivariable models. Conclusions Non-ruptured TCFA, not plaque rupture can identify plaques at increased risk of subsequent events. Patients with non-culprit plaque rupture had a poor long-term prognosis, which is predominantly due to the effect of non-ruptured TCFA.