Presence of ≥1 long non-culprit lesion in patients with acute myocardial infarction was associated with a higher risk of NCL-related MACE (7.3% vs. 2.9%; adjusted HR 2.26; 95% CI 1.19-4.29).
Cohort (n=1,278)
Does the presence of long non-culprit lesions detected by OCT predict NCL-related major adverse cardiovascular events in patients with acute myocardial infarction?
OCT-detected long non-culprit lesions, particularly long thin-cap fibroatheromas, are associated with a significantly higher risk of 5-year adverse events in patients with AMI.
Hazard Ratio: 2.26 (95% CI 1.19–4.29)
Absolute Event Rate: 7.3% vs 2.9%
BACKGROUND: This study aimed to investigate plaque characteristics and long-term outcomes associated with long non-culprit lesions (NCLs) in patients with acute myocardial infarction (AMI). METHODS: A total of 1278 AMI patients undergoing three-vessel optical coherence tomography (OCT) were retrospectively enrolled, and 5131 NCLs were identified. A long lesion was defined as an OCT lesion ≥20 mm in length. Patients were followed for up to 5 years, and NCL-related major adverse cardiovascular events (NCL-MACE) were recorded. RESULTS: Both at the patient and lesion level, long NCLs were more stenotic and had more frequent thin-cap fibroatheroma (TCFA) and other vulnerable plaque features than short NCLs (all P < 0.001). During a median follow-up of 4.1 years, patients with ≥1 long NCL had a significantly higher incidence of NCL-MACE than patients without long NCL (7.3% vs. 2.9%, adjusted HR: 2.26, 95%CI: 1.19-4.29). Similar findings were identified when patients were grouped by angiographic lesion length. In the lesion-level analysis, OCT-detected long NCLs remained significantly associated with NCL-MACE after adjustment for TCFA (adjusted HR: 1.97, 95%CI: 1.11-3.52), whereas angiography-detected long NCLs showed no prognostic value. Notably, OCT-detected long TCFA had highest lesion-specific risk (5.4% vs. 1.1%, adjusted HR: 3.69, 95%CI: 1.87-7.27), whereas risk of OCT-detected short TCFA was comparable to that of non-TCFA (1.1% vs. 1.1%, P = 0.986). CONCLUSIONS: Long NCLs were indicative of higher levels of pancoronary plaque vulnerability, irrespective of detection via OCT or angiography. Importantly, OCT-detected long NCLs, especially long TCFA, offered significant predictive value for 5-year adverse events. However, angiography-detected long NCLs lacked prognostic significance.
Cui et al. (Mon,) conducted a cohort in acute myocardial infarction (AMI) (n=1,278). Long non-culprit lesions (≥20 mm) vs. Without long non-culprit lesions was evaluated on NCL-related major adverse cardiovascular events (NCL-MACE) (adjusted HR 2.26, 95% CI 1.19-4.29). Presence of ≥1 long non-culprit lesion in patients with acute myocardial infarction was associated with a higher risk of NCL-related MACE (7.3% vs. 2.9%; adjusted HR 2.26; 95% CI 1.19-4.29).