Optical coherence tomography detection of non-culprit coronary lesions vulnerable plaques at high risk of developing major adverse cardiovascular events
10.3969/j.issn.1004-8812.2024.11.005
- VernacularTitle:光学相干断层成像对急性冠状动脉综合征患者非罪犯病变易损斑块的分析及预后评估的研究
- Author:
Hong YANG
1
;
Sen LIU
;
Cheng LIU
;
Meng-Wei WEI
;
Qi-Qi SHAO
;
Ya-Qi ZHOU
;
Zhen-Yan FU
Author Information
1. 新疆医科大学第一附属医院(第一临床医学院)心脏中心,新疆乌鲁木齐 830054
- Keywords:
Acute coronary syndrome;
Non-culprit coronary lesions;
Vulnerable plaque;
Percutaneous coronary intervention;
Optical coherence tomography
- From:
Chinese Journal of Interventional Cardiology
2024;32(11):635-641
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the value of optical coherence tomography(OCT)in predicting the risk of major adverse cardiovascular events(MACE)in patients of acute coronary syndrome(ACS).Methods Four hundred and forth-eight ACS patients admitted to the First Affiliated Hospital of Xinjiang Medical University who underwent percutaneous coronary intervention(PCI)and OCT from February 2015 to February 2022 were selected as the study subjects.We found 749 non-culprit coronary lesions.And follow up the patients,median follow-up was 5 years[interquartile interval(IQR):3-7 years].Kaplan-meier was used to estimate the cumulative incidence of MACE,multivariate Cox regression was used to analyze the risk of MACE with OCT parameters non-culprit coronary lesions,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of OCT parameters for MACE in non-culprit coronary lesions.Results A total of 749 non-culprit coronary lesions were detected,and 41 MACE cases were caused by non-culprit coronary lesions imaged by OCT.Compared with plaques without thin-cap fibroatheroma(TCFA)and minimal lumen area(MLA)＜3.5 mm2,the incidence of MACE was significantly associated with vulnerable plaques with TCFA and MLA＜3.5 mm2(33％vs.3％,HR 13.62,95％CI 6.71-27.65,P＜0.001).Multivariate Cox regression analysis showed that larger maximum lipid arc(HR 1.02,95％CI 1.01-1.03,P＜0.001),smaller maximum lipid cap thickness(HR 0.97,95％CI 0.96-0.99,P＜0.001)and MLA(HR 0.31,95％CI 0.18-0.55,P＜0.001)were independent risk factors for MACE.The area under ROC curve(AUC)of the thinnest fiber cap thickness for predicting MACE occurrence was 0.858(95％CI 0.802-0.913),and the optimal cutoff value was 66.5 μm.The AUC of maximum lipid arc for predicting MACE occurrence was 0.853(95％CI 0.786-0.920),and the optimal cut-off value was 180.35°.The AUC of MLA for predicting MACE was 0.821(95％CI 0.766-0.876),and the optimal cutoff was 3.575 mm2.Conclusions The non-culprit coronary lesions with TCFA and MLA＜3.5 mm2 were significantly associated with an increased risk of subsequent MACE development at the lesion level,and OCT imaging helps early identification of the risk of MACE development in non-culprit coronary lesions in patients of ACS.
