Key result
High radial wall strain links to an almost fivefold increase in 5-year non-target vessel events.
Why the study?
Untreated non-target vessels with vulnerable plaques remain a major contributor to future adverse cardiovascular events after PCI, and plaque strain assessment traditionally requires complex and expensive imaging.
Does radial wall strain (RWS) assessment from routine angiography predict future cardiac events in non-target vessels over 5 years in patients after percutaneous coronary intervention?
RCT
Blinded analysis
Does radial wall strain (RWS) assessment from routine angiography predict future cardiac events in non-target vessels over 5 years in patients after percutaneous coronary intervention?
Automated assessment of radial wall strain from routine angiography strongly predicts 5-year non-target vessel-related adverse cardiovascular events after percutaneous coronary intervention.
May enable real-time plaque vulnerability assessment during PCI; leaves open impact on risk stratification and outcomes.
BACKGROUND: Percutaneous coronary intervention effectively treats flow-limiting stenoses; however, untreated non-target vessels with vulnerable plaques remain a major contributor to future adverse cardiovascular events. Plaque strain is a promising marker of plaque vulnerability but traditionally requires complex modelling and expensive intracoronary imaging. We developed a novel artificial intelligence algorithm for subpixel-level lumen delineation, enabling real-time automated assessment of radial wall strain (RWS) from routine angiography. AIMS: This post hoc study sought to determine the prognostic value of RWS for predicting future cardiac events in non-target vessels over 5 years, using the high-quality TARGET All Comers randomised trial. METHODS: ) ≥13% was used to define increased plaque vulnerability. The primary endpoint was a non-target vessel-oriented composite endpoint (NT-VOCE), a composite of cardiac death, non-target vessel myocardial infarction and non-target vessel revascularisation over 5 years, as prospectively adjudicated in the parent trial. Following blinded RWS analysis, the results were integrated into the trial database, and the outcomes were unblinded and linked to corresponding vessel-level outcomes. RESULTS: independently predicted the NT-VOCE, with an adjusted hazard ratio (HR) of 4.82 (95% confidence interval [CI]: 3.14-7.40; p<0.0001) and an adjusted area under the curve (AUC) of 0.73 (95% CI: 0.69-0.78; p<0.0001). Predictive accuracy was highest for non-target vessel revascularisation (adjusted AUC 0.92, 95% CI: 0.88-0.95; p<0.0001). In the subgroup with high-quality angiographic images, RWS demonstrated even greater predictive performance for the NT-VOCE (adjusted HR 6.89, 95% CI: 3.15-15.07; p<0.0001). CONCLUSIONS: was strongly associated with the NT-VOCE, with the highest predictive accuracy in vessels with high-quality angiographic imaging. Ongoing and planned prospective, randomised trials are evaluating the role of RWS-guided risk stratification.
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Huang et al. (2026) conducted an RCT in Untreated non-target vessels post-percutaneous coronary intervention. Radial wall strain (RWS) ≥13% was evaluated on Non-target vessel-oriented composite endpoint (NT-VOCE) of cardiac death, non-target vessel myocardial infarction, and non-target vessel revascularisation (HR 4.82, 95% CI 3.14-7.40, p=<0.0001). Increased radial wall strain (≥13%) independently predicted the non-target vessel-oriented composite endpoint over 5 years (HR 4.82; 95% CI 3.14-7.40; p<0.0001).
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