TY - JOUR
T1 - Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial Infarction
T2 - A Prospect II Substudy
AU - Arslani, Ketina
AU - Engstrøm, Thomas
AU - Maeng, Michael
AU - Kjøller-Hansen, Lars
AU - Maehara, Akiko
AU - Zhou, Zhipeng
AU - Ben-Yehuda, Ori
AU - Bøtker, Hans Erik
AU - Matsumura, Mitsuaki
AU - Mintz, Gary S
AU - Fröbert, Ole
AU - Persson, Jonas
AU - Wiseth, Rune
AU - Larsen, Alf I
AU - Jensen, Lisette O
AU - Nordrehaug, Jan E
AU - Bleie, Øyvind
AU - Omerovic, Elmir
AU - Held, Claes
AU - James, Stefan K
AU - Ali, Ziad A
AU - Erlinge, David
AU - Stone, Gregg W
N1 - Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2025/6
Y1 - 2025/6
N2 - BACKGROUND: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions.OBJECTIVES: The authors aimed to assess whether pressure-wire-based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics.METHODS: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%.RESULTS: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm2 (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not.CONCLUSIONS: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II [PROSPECT II]; NCT02171065).
AB - BACKGROUND: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions.OBJECTIVES: The authors aimed to assess whether pressure-wire-based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics.METHODS: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%.RESULTS: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm2 (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not.CONCLUSIONS: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II [PROSPECT II]; NCT02171065).
KW - acute myocardial infarction
KW - coronary physiology
KW - intravascular imaging
KW - vulnerable plaque
KW - Myocardial Infarction/physiopathology
KW - Predictive Value of Tests
KW - Coronary Artery Disease/physiopathology
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Ultrasonography, Interventional
KW - Male
KW - Cardiac Catheterization
KW - Spectroscopy, Near-Infrared
KW - Female
KW - Severity of Illness Index
KW - Risk Factors
KW - Plaque, Atherosclerotic
KW - Coronary Angiography
KW - Fractional Flow Reserve, Myocardial
KW - Coronary Stenosis/physiopathology
KW - Aged
KW - Coronary Vessels/diagnostic imaging
KW - Hemodynamics
KW - Percutaneous Coronary Intervention
KW - Rupture, Spontaneous
UR - http://www.scopus.com/inward/record.url?scp=85218883000&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2024.11.002
DO - 10.1016/j.jcmg.2024.11.002
M3 - Journal article
C2 - 39998456
SN - 1936-878X
VL - 18
SP - 696
EP - 706
JO - JACC. Cardiovascular imaging
JF - JACC. Cardiovascular imaging
IS - 6
ER -