Key result
OCT-detected thin-cap fibroatheroma is non-significantly associated with higher 3-month MACE rates after primary PCI.
Why the study?
While PCI is the definitive reperfusion strategy for STEMI, residual disease burden and plaque vulnerability both influence clinical recovery. The descriptive characteristics and short-term outcomes of combining the residual SYNTAX score with OCT-derived thin-cap fibroatheroma in STEMI patients needed exploration.
Does combining post-PCI residual SYNTAX score with OCT-derived culprit lesion thin-cap fibroatheroma stratify the risk of 3-month major adverse cardiac events in patients with STEMI undergoing primary PCI?
Observational (n=30)
Outcome assessors blinded
No
Does combining post-PCI residual SYNTAX score with OCT-derived culprit lesion thin-cap fibroatheroma stratify the risk of 3-month major adverse cardiac events in patients with STEMI undergoing primary PCI?
In this exploratory pilot study of STEMI patients undergoing PCI, the presence of OCT-derived culprit lesion TCFA was descriptively associated with a higher rate of 3-month MACE across both complete and incomplete revascularization strata, though differences were not statistically significant.
Background ST-elevation myocardial infarction (STEMI) remains a leading cause of global morbidity and mortality. While percutaneous coronary intervention (PCI) is the definitive reperfusion strategy, residual disease burden and plaque vulnerability both influence clinical recovery. The residual SYNTAX score (rSS) quantifies untreated macroscopic coronary artery disease, whereas optical coherence tomography (OCT) resolves microscopic plaque architecture, notably thin-cap fibroatheroma (TCFA). This pilot study explored the descriptive characteristics and short-term outcomes associated with combining rSS and OCT-derived TCFA in a highly selected STEMI cohort. Methods This retrospective observational pilot study included 30 patients with STEMI who underwent primary PCI and culprit lesion OCT evaluation at a tertiary care center. Patients were stratified into four groups according to the presence of culprit TCFA and the post-PCI rSS threshold ( ≤ ≤ 4 vs. > 4): group 0 (TCFA absent, rSS > 4), group 1 (TCFA absent, rSS ≤ ≤ 4), group 2 (TCFA present, rSS > 4), and group 3 (TCFA present, rSS ≤ ≤ 4). The primary clinical endpoint was major adverse cardiac events (MACE)—a composite of all-cause death, recurrent myocardial infarction, target lesion revascularization, heart failure hospitalisation, and ischemic stroke—assessed over 3 months. Results The cohort (mean age, 54.5 ± 10.1 years; 83.3% male, 40% with diabetes mellitus) had a 53.3% prevalence (16 of 30) of culprit lesion TCFA. Complete or reasonable revascularization (rSS ≤ 4) was achieved in 12 patients (40.0%). The overall cumulative 3-month MACE rate was 30.0% (9 of 30). MACE occurred in 1 of 7 patients (14.3%) in group 0, 1 of 7 (14.3%) in group 1, 4 of 11 (36.4%) in group 2, and 3 of 5 (60.0%) in group 3 (Fisher exact test, P = 0.23; log-rank P = 0.38). Patients with TCFA accounted for 7 of 9 clinical events (77.8%). Given the small subgroup sizes ( n < 12), multivariable predictive risk modeling was not performed. Conclusions In this exploratory pilot cohort of STEMI patients undergoing PCI, the presence of OCT-derived TCFA was descriptively associated with higher short-term adverse event rates across both complete and incomplete revascularization strata. Given the small sample size and clear indication bias, these findings are strictly hypothesis-generating and support the need for adequately powered prospective registries to evaluate dual anatomical-biological risk stratification.
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Syed et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=30). Presence of OCT-derived thin-cap fibroatheroma (TCFA) and residual SYNTAX score (rSS <=4 vs >4) vs. Absence of culprit lesion TCFA (with rSS <=4 or >4) was evaluated on Major adverse cardiac events (MACE: composite of all-cause death, recurrent myocardial infarction, target lesion revascularization, heart failure hospitalization, and ischemic stroke) at 3 months (p=0.23). OCT-derived thin-cap fibroatheroma was descriptively associated with higher 3-month MACE rates (43.8% vs 14.3%; P=0.23 across rSS strata) in STEMI patients undergoing primary PCI.
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