Key result
NSTEMI culprit artery occlusion is linked to ~59% more plaque rupture but similar 2-year MACE.
Why the study?
Occlusion of the culprit artery is seen in many NSTEMI patients with poor prognosis, but the morphological features of culprit plaques across these phenotypes remain unclear.
Does occlusion of the culprit artery impact plaque morphology and clinical outcomes in NSTEMI patients compared to non-occlusion?
Cohort (n=324)
No
Does occlusion of the culprit artery impact plaque morphology and clinical outcomes in NSTEMI patients compared to non-occlusion?
NSTEMI patients with an occluded culprit artery exhibit more vulnerable plaque morphologies resembling STEMI, and delayed catheterization in this subgroup independently predicts worse clinical outcomes.
OCT plaque differences in OCA-NSTEMI may aid phenotyping; leaves open whether morphology informs management or trials.
BACKGROUND: Occlusion of the culprit artery (OCA) is observed in a substantial proportion of non-ST-segment elevation myocardial infarction (NSTEMI) patients, showing a poor clinical prognosis. NSTEMI management remains challenging, potentially due to pathophysiological mechanisms across different clinical phenotypes. This study investigated the morphological features of culprit plaque in NSTEMI with vs. without OCA. METHODS AND RESULTS: In all, 324 NSTEMI patients who underwent optical coherence tomography (OCT) imaging were enrolled in this study. Patients were divided into an OCA group (n=105; 32.4%) and a non-OCA group (n=219; 67.6%). Compared with the non-OCA group, the OCA group had significantly higher rates of plaque rupture (67.6% vs. 42.5%; P<0.001), lipid-rich plaque (81.0% vs. 67.1%; P=0.01), thin-cap fibroatheroma (48.6% vs. 25.1%; P<0.001), thrombus (88.6% vs. 66.7%; P<0.001), macrophage accumulation (92.4% vs. 76.7%; P<0.001), and cholesterol crystals (48.6% vs. 27.4%; P<0.001) on OCT. Symptom-to-catheter time was found to be an independent predictor of 2-year major adverse cardiovascular events for OCA patients. CONCLUSIONS: The underlying plaque morphologies were different between OCA and non-OCA patients. The OCA had a higher rate of plaque rupture, with more features (e.g., lipid-rich plaque, thin-cap fibroatheroma, thrombus, macrophage accumulation, cholesterol crystals) resembling ST-elevation myocardial infarction-like plaques. Symptom-to-catheter time was an independent predictor of major adverse cardiovascular events in the OCA group.
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Shao et al. (2026) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=324). Occlusion of the culprit artery (OCA) vs. Non-occlusion of the culprit artery (non-OCA) was evaluated on 2-year major adverse cardiovascular events (MACE). Occlusion of the culprit artery in NSTEMI patients was associated with higher rates of plaque rupture (67.6% vs. 42.5%) compared to non-occlusion, while 2-year MACE rates were similar.