Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction

Background Total coronary atherosclerotic plaque activity across the entire coronary arterial tree is associated with patient-level clinical outcomes. Objectives We aimed to investigate whether vessel-level coronary atherosclerotic plaque activity is associated with vessel-level myocardial infarction. Methods In this secondary analysis of an international multicenter study of patients with recent myocardial infarction and multivessel coronary artery disease, we assessed vessel-level coronary atherosclerotic plaque activity using coronary 18F-sodium fluoride positron emission tomography to identify vessel-level myocardial infarction. Results Increased 18F-sodium fluoride uptake was found in 679 of 2094 coronary arteries and 414 of 691 patients respectively. Myocardial infarction occurred in 24 (4%) vessels with increased coronary atherosclerotic plaque activity and in 25 (2%) vessels without increased coronary atherosclerotic plaque activity (hazard ratio, 2.08; 95% confidence interval, 1.16 to 3.72; P=0.013). This association was not demonstrable in those treated with coronary revascularization (hazard ratio, 1.02; 95% confidence interval, 0.47 to 2.25) but was notable in untreated vessels (hazard ratio, 3.86; 95% confidence interval, 1.63 to 9.10) (Pinteraction=0.024). Increased coronary atherosclerotic plaque activity in multiple coronary arteries was associated with heightened patient-level risk of cardiac death or myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.37 to 4.30; P=0.002) as well as first (hazard ratio, 2.19; 95% confidence interval, 1.18 to 4.06; P=0.013) and total (hazard ratio, 2.50; 95% confidence interval, 1.42 to 4.39; P=0.002) myocardial infarctions. Conclusions In patients with recent myocardial infarction and multivessel coronary artery disease, coronary atherosclerotic plaque activity prognosticates individual coronary arteries and patients at risk for myocardial infarction.