TY - JOUR
T1 - Silent plaque ruptures in non-obstructive lesions of non-infarct-related arteries
T2 - a multimodality, serial intracoronary imaging study
AU - Kakizaki, Ryota
AU - Biccirè, Flavio G
AU - Losdat, Sylvain
AU - Ueki, Yasushi
AU - Häner, Jonas D
AU - Shibutani, Hiroki
AU - Otsuka, Tatsuhiko
AU - Bär, Sarah
AU - Lønborg, Jacob
AU - Spitzer, Ernest
AU - Siontis, George C M
AU - Ondracek, Anna S
AU - van Geuns, Robert-Jan
AU - Wang, Yu-Jen
AU - Matter, Christian M
AU - Iglesias, Juan F
AU - Spirk, David
AU - Daemen, Joost
AU - Fahrni, Gregor
AU - Mahfoud, Felix
AU - Engstrøm, Thomas
AU - Lang, Irene M
AU - Koskinas, Konstantinos C
AU - Räber, Lorenz
N1 - © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2026/6/9
Y1 - 2026/6/9
N2 - BACKGROUND AND AIMS: Plaque rupture can occur at non-obstructive lesions in non-infarct-related coronary arteries (non-IRAs) without inducing ischaemia. This study aimed to: (1) assess the frequency and lesion characteristics of plaque rupture in non-IRAs of acute myocardial infarction (AMI) patients, (2) evaluate morphological changes in rupture sites over 52 weeks, and (3) investigate the baseline morphology of new-onset ruptures.METHODS: This study analysed pooled data from the IBIS-4 and PACMAN-AMI trials. Patients presenting with AMI underwent multimodality intracoronary imaging of non-IRAs at baseline and after 52 weeks.RESULTS: Among 783 lesions from 336 patients evaluated at baseline, plaque rupture was observed in 41 lesions of 40 patients (12%). Biomarkers including lipid and inflammation markers were comparable between patients with and without rupture in non-IRAs. Lesions with rupture showed larger percent atheroma volume (53.3 ± 6.4 vs. 49.5 ± 5.8%, estimated difference 3.6[1.9 to 5.4]), larger external elastic membrane area (20.5 ± 4.8 vs. 15.7 ± 5.6 mm2, 4.1[2.5 to 5.7]), and smaller minimum fibrous cap thickness (69 ± 49 vs. 116 ± 84 μm, -43[-75 to -11]) compared to those without. Among 41 rupture sites assessed serially, 21 (51%) healed by 52 weeks. At follow-up, 10 rupture sites were newly identified, and thin-cap fibroatheroma was the most frequent baseline morphology of those.CONCLUSIONS: Plaque rupture in non-obstructive lesions of non-IRAs was present in 12% of AMI patients. Larger plaque volume, positive remodeling, and thinner fibrous cap were associated with rupture. More than half of untreated ruptures transitioned into stable morphologies. Thin-cap fibroatheroma was the most frequent underlying morphology of new-onset rupture.
AB - BACKGROUND AND AIMS: Plaque rupture can occur at non-obstructive lesions in non-infarct-related coronary arteries (non-IRAs) without inducing ischaemia. This study aimed to: (1) assess the frequency and lesion characteristics of plaque rupture in non-IRAs of acute myocardial infarction (AMI) patients, (2) evaluate morphological changes in rupture sites over 52 weeks, and (3) investigate the baseline morphology of new-onset ruptures.METHODS: This study analysed pooled data from the IBIS-4 and PACMAN-AMI trials. Patients presenting with AMI underwent multimodality intracoronary imaging of non-IRAs at baseline and after 52 weeks.RESULTS: Among 783 lesions from 336 patients evaluated at baseline, plaque rupture was observed in 41 lesions of 40 patients (12%). Biomarkers including lipid and inflammation markers were comparable between patients with and without rupture in non-IRAs. Lesions with rupture showed larger percent atheroma volume (53.3 ± 6.4 vs. 49.5 ± 5.8%, estimated difference 3.6[1.9 to 5.4]), larger external elastic membrane area (20.5 ± 4.8 vs. 15.7 ± 5.6 mm2, 4.1[2.5 to 5.7]), and smaller minimum fibrous cap thickness (69 ± 49 vs. 116 ± 84 μm, -43[-75 to -11]) compared to those without. Among 41 rupture sites assessed serially, 21 (51%) healed by 52 weeks. At follow-up, 10 rupture sites were newly identified, and thin-cap fibroatheroma was the most frequent baseline morphology of those.CONCLUSIONS: Plaque rupture in non-obstructive lesions of non-IRAs was present in 12% of AMI patients. Larger plaque volume, positive remodeling, and thinner fibrous cap were associated with rupture. More than half of untreated ruptures transitioned into stable morphologies. Thin-cap fibroatheroma was the most frequent underlying morphology of new-onset rupture.
KW - Intravascular ultrasound
KW - Near-infrared spectroscopy
KW - Non-culprit lesion
KW - Optical coherence tomography
KW - Thin-cap fibroatheroma
KW - Vulnerable plaque
UR - https://www.scopus.com/pages/publications/105041338582
U2 - 10.1093/eurheartj/ehag037
DO - 10.1093/eurheartj/ehag037
M3 - Journal article
C2 - 41795942
SN - 1522-9645
VL - 47
SP - 2814
EP - 2826
JO - European Heart Journal
JF - European Heart Journal
IS - 22
ER -