Underlying Plaque Type and Neoatherosclerosis After ST-Segment Elevation Myocardial Infarction ― Serial Optical Coherence Tomography Substudy of the CONNECT Trial ―

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (n=144). Intervention: Neoatherosclerosis-leading segments (underlying lipid-rich plaque) vs. Non-neoatherosclerosis-leading lesions. Primary outcome: Proportion of post-PCI OCT frames with underlying lipid-rich plaque at baseline (OR 2.72, 95% CI 1.23-6.01, p=0.011).

Q: What does this research mean for the field?

Baseline lipid-rich plaque is significantly associated with the development of neoatherosclerosis at 3 years following ST-segment elevation myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ryota Kakizaki; Jonas Dominik Häner; Marco Gamardella; Masanori Taniwaki; Yohei Ohno; Kazuyuki Yahagi; Yoshiharu Higuchi; G Siontis; Kenji Andò; Stefan Stortecky; Nobuaki Suzuki; Naoki Watanabe; Jonas Lanz; Yasushi Ueki; Tatsuhiko Otsuka; Flavio Giuseppe Biccirè; Masami Sakurada; Konstantinos C. Koskinas; Sylvain Losdat; Lorenz Räber

doi:10.1253/circj.cj-26-0286

Key result

Baseline lipid-rich plaque is linked to ~2.7-fold higher odds of neoatherosclerosis after STEMI.

OR 2.72
95% CI 1.23-6.01
P=0.011
n=144

Key Points

To assess the association between baseline plaque type and the development of neoatherosclerosis after ST-segment elevation myocardial infarction.
Serial optical coherence tomography substudy nested within the CONNECT clinical trial.
Evaluated coronary plaque morphology and subsequent stent neoatherosclerosis in patients treated for ST-segment elevation myocardial infarction.
Assessed the relationship between original plaque characteristics and subsequent neoatherosclerosis formation.
Specific quantitative endpoints and comparative effect sizes were not reported in the provided abstract text.

Study Design

Type

Observational (n=144)

Blinding

Assessor-blinded

Multicenter

Yes

PICO

P

Population

144 patients (mean age 62.5 years, 16% female) with STEMI undergoing primary PCI with everolimus-eluting stents and serial post-procedural and 3-year follow-up OCT imaging.

E

Exposure / Comparator

Neoatherosclerosis-leading segments (underlying lipid-rich plaque) vs Non-neoatherosclerosis-leading lesions

O

Primary Outcome

Proportion of post-PCI OCT frames with underlying lipid-rich plaque at baseline — OR 2.72 (1.23-6.01), p=0.011

Main Result

Odds Ratio: 2.72 (95% CI 1.23–6.01)

Absolute Event Rate: 71% vs 54%

p-value: p=0.011

Limitations

Not all CONNECT trial participants underwent serial OCT of the culprit stent, which may have introduced selection bias.
Small number of lesions developing neoatherosclerosis at 3 years (n=17), resulting in limited statistical power for segment-level and lesion-level analyses.
Included only patients with STEMI, in whom fibrous and fibrocalcific plaques are less prevalent compared with chronic coronary syndromes, limiting generalizability.
Classification of underlying plaque type was based on post-PCI OCT imaging, where morphology may have been altered and distinguishing lipid-rich plaque from red thrombus behind stent struts is challenging.
The proportion of patients with diabetes was lower than in contemporary clinical practice.

Implication

Baseline lipid-rich plaques may flag higher neoatherosclerosis risk post-STEMI; hypothesis-generating and should not yet change practice.

Abstract

Background: The relationship between underlying plaque type and the development of neoatherosclerosis remains uncertain.

Discussion

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Cite This Study

Kakizaki et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (n=144). Neoatherosclerosis-leading segments (underlying lipid-rich plaque) vs. Non-neoatherosclerosis-leading lesions was evaluated on Proportion of post-PCI OCT frames with underlying lipid-rich plaque at baseline (OR 2.72, 95% CI 1.23-6.01, p=0.011). Neoatherosclerosis-leading segments had a higher proportion of baseline lipid-rich plaque frames than non-neoatherosclerosis lesions (71% vs 54%; OR 2.72, 95% CI 1.23-6.01) at 3 years after STEMI.

synapsesocial.com/papers/6ae28f09cbadf70daf6c4412 https://doi.org/10.1253/circj.cj-26-0286

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Underlying Plaque Type and Neoatherosclerosis After ST-Segment Elevation Myocardial Infarction ― Serial Optical Coherence Tomography Substudy of the CONNECT Trial ―

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Underlying Plaque Type and Neoatherosclerosis After ST-Segment Elevation Myocardial Infarction ― Serial Optical Coherence Tomography Substudy of the CONNECT Trial ―

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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