Why the study?
Complete non-culprit revascularisation may reduce recurrent events after NSTEMI if non-culprit lesions harbour high-risk plaque features similar to STEMI, but differences in plaque morphology and clinical associations remained unclear.
Does the prevalence of optical coherence tomography-identified high-risk plaque in FFR-negative non-culprit lesions and its association with 2-year major adverse cardiovascular events differ between patients presenting with NSTEMI versus STEMI?
Does the prevalence of optical coherence tomography-identified high-risk plaque in FFR-negative non-culprit lesions and its association with 2-year major adverse cardiovascular events differ between patients presenting with NSTEMI versus STEMI?
FFR-negative non-culprit lesions in NSTEMI and STEMI patients have a comparable prevalence of OCT-identified high-risk plaques (~30%), which is associated with numerically higher 2-year MACE in both groups and significant risk when plaque rupture is present.
May indicate higher event risk in NSTEMI; leaves open whether OCT assessment of non-culprit plaques should guide therapy.
AIMS: Complete non-culprit (NC) revascularisation may help reduce recurrent events after non-ST-segment elevation myocardial infarction (NSTEMI), especially if NC lesions would harbour high-risk plaque (HRP) features similar to ST-segment elevation myocardial infarction (STEMI). This study aimed to assess differences in fractional flow reserve (FFR)-negative NC plaque morphology in patients presenting with NSTEMI vs. STEMI and assess the association of HRP morphology and clinical outcome. METHODS AND RESULTS: In the prospective PECTUS-obs study, 438 patients presenting with myocardial infarction (MI) underwent optical coherence tomography (OCT) of all FFR-negative intermediate NC lesions. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE, composite of all-cause mortality, non-fatal MI or unplanned revascularisation) at 2-year follow-up. Four hundred and twenty patients had at least one analysable OCT, including 203 (48.3%) with NSTEMI and 217 (51.7%) with STEMI. The prevalence of HRPs, including thin-cap fibroatheromas, plaque rupture, and thrombus, was comparable between groups. MACE occurred in 29 (14.3%) NSTEMI patients and 16 (7.4%) STEMI patients (Puni-variable = 0.025 and Pmulti-variable = 0.270). Incidence of MACE was numerically higher among patients with HRP, irrespective of the clinical presentation at index (Pinteraction = 0.684). Among HRP criteria, plaque rupture was associated with MACE in both NSTEMI (P < 0.001) and STEMI (P = 0.020). CONCLUSION: Presence of NC HRP is comparable between NSTEMI and STEMI and leads to numerically higher event rates in both. These results call for additional research on complete revascularisation in NSTEMI and treatment of HRP. CLINICAL TRIAL REGISTRATION: NCT03857971.
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Volleberg et al. (2024) studied this question.
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