Natalia Pinilla-Echeverri1, Shamir R Mehta1, Jia Wang1, Shahar Lavi2, Erick Schampaert3, Warren J Cantor4, Kevin R Bainey5, Robert C Welsh5, Saleem Kassam6, Roxana Mehran7, Robert F Storey8, Helen Nguyen1, Brandi Meeks1, David A Wood9, John A Cairns9, Tej Sheth1. 1. Population Health Research Institute, McMaster University and Hamilton Health Sciences, ON, Canada (N.P.-E., S.R.M., J.W., H.N., B.M., T.S.). 2. London Health Sciences Centre, Western University, ON, Canada (S.L.). 3. Hôpital du Sacré-Cœur de Montréal, Université de Montréal, QC, Canada (E.S.). 4. Southlake Regional Health Centre, University of Toronto, ON, Canada (W.J.C.). 5. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada (K.R.B., R.C.W.). 6. Scarborough Health Network-Centenary site, ON, Canada (S.K.). 7. The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). 8. Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom (R.F.S.). 9. Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada (D.A.W., J.A.C.).
Abstract
BACKGROUND: Complete revascularization with routine percutaneous coronary intervention of nonculprit lesions after primary percutaneous coronary intervention improves outcomes in ST-segment-elevation myocardial infarction. Whether this benefit is associated with nonculprit lesion vulnerability is unknown. METHODS: In a prospective substudy of the COMPLETEs trial (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI), we performed optical coherence tomography of at least 2 coronary arteries before nonculprit lesion percutaneous coronary intervention in 93 patients with ST-segment-elevation myocardial infarction and multivessel disease; and the ST-segment-elevation myocardial infarction culprit vessel if there was unstented segment amenable to imaging. Nonculprit lesions were categorized as obstructive (≥70% stenosis by visual angiographic assessment) or nonobstructive, and as thin-cap fibroatheroma (TCFA) or non-TCFA by optical coherence tomography criteria. TCFA was defined as a lesion with mean fibrous cap thickness <65 μm overlying a lipid arc >90°. RESULTS: On a patient level, at least one obstructive TCFA was observed in 44/93 (47%) of patients. On a lesion level, there were 58 TCFAs among 150 obstructive nonculprit lesions compared with 74 TCFAs among 275 nonculprit lesions (adjusted TCFA prevalence: 35.4% versus 23.2%, P=0.022). Compared with obstructive non-TCFAs, obstructive TCFAs had similar lesion length (23.1 versus 20.8 mm, P=0.16) but higher lipid quadrants (55.2 versus 19.2, P<0.001), greater mean lipid arc (203.8° versus 84.5°, P<0.001), and more macrophages (97.1% versus 54.4%, P<0.001) and cholesterol crystals (85.8% versus 44.3%, P<0.001). For nonobstructive lesions, TCFA lesions had similar lesion length (16.7 versus 14.6 mm, P=0.11), but more lipid quadrants (36.4 versus 13.5, P<0.001), and greater mean lipid arc (191.8° versus 84.2°, P<0.001) compared with non-TCFA. CONCLUSIONS: Among patients who underwent optical coherence tomography imaging in the COMPLETE trial, nearly 50% had at least one obstructive nonculprit lesion containing complex vulnerable plaque. Obstructive lesions more commonly harbored vulnerable plaque morphology than nonobstructive lesions. This may help explain the benefit of routine percutaneous coronary intervention of obstructive nonculprit lesions in patients with ST-segment-elevation myocardial infarction and multivessel disease. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01740479s.
BACKGROUND: Complete revascularization with routine percutaneous coronary intervention of nonculprit lesions after primary percutaneous coronary intervention improves outcomes in ST-segment-elevation myocardial infarction. Whether this benefit is associated with nonculprit lesion vulnerability is unknown. METHODS: In a prospective substudy of the COMPLETEs trial (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI), we performed optical coherence tomography of at least 2 coronary arteries before nonculprit lesion percutaneous coronary intervention in 93 patients with ST-segment-elevation myocardial infarction and multivessel disease; and the ST-segment-elevation myocardial infarction culprit vessel if there was unstented segment amenable to imaging. Nonculprit lesions were categorized as obstructive (≥70% stenosis by visual angiographic assessment) or nonobstructive, and as thin-cap fibroatheroma (TCFA) or non-TCFA by optical coherence tomography criteria. TCFA was defined as a lesion with mean fibrous cap thickness <65 μm overlying a lipid arc >90°. RESULTS: On a patient level, at least one obstructive TCFA was observed in 44/93 (47%) of patients. On a lesion level, there were 58 TCFAs among 150 obstructive nonculprit lesions compared with 74 TCFAs among 275 nonculprit lesions (adjusted TCFA prevalence: 35.4% versus 23.2%, P=0.022). Compared with obstructive non-TCFAs, obstructive TCFAs had similar lesion length (23.1 versus 20.8 mm, P=0.16) but higher lipid quadrants (55.2 versus 19.2, P<0.001), greater mean lipid arc (203.8° versus 84.5°, P<0.001), and more macrophages (97.1% versus 54.4%, P<0.001) and cholesterol crystals (85.8% versus 44.3%, P<0.001). For nonobstructive lesions, TCFA lesions had similar lesion length (16.7 versus 14.6 mm, P=0.11), but more lipid quadrants (36.4 versus 13.5, P<0.001), and greater mean lipid arc (191.8° versus 84.2°, P<0.001) compared with non-TCFA. CONCLUSIONS: Among patients who underwent optical coherence tomography imaging in the COMPLETE trial, nearly 50% had at least one obstructive nonculprit lesion containing complex vulnerable plaque. Obstructive lesions more commonly harbored vulnerable plaque morphology than nonobstructive lesions. This may help explain the benefit of routine percutaneous coronary intervention of obstructive nonculprit lesions in patients with ST-segment-elevation myocardial infarction and multivessel disease. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01740479s.
Authors: Andrew Lin; Márton Kolossváry; Sebastien Cadet; Priscilla McElhinney; Markus Goeller; Donghee Han; Jeremy Yuvaraj; Nitesh Nerlekar; Piotr J Slomka; Mohamed Marwan; Stephen J Nicholls; Stephan Achenbach; Pál Maurovich-Horvat; Dennis T L Wong; Damini Dey Journal: JACC Cardiovasc Imaging Date: 2022-01-12
Authors: Dario Tino Bertolone; Emanuele Gallinoro; Giuseppe Esposito; Pasquale Paolisso; Konstantinos Bermpeis; Cristina De Colle; Davide Fabbricatore; Niya Mileva; Chiara Valeriano; Daniel Munhoz; Marta Belmonte; Marc Vanderheyden; Jozef Bartunek; Jeroen Sonck; Eric Wyffels; Carlos Collet; Costantino Mancusi; Carmine Morisco; Nicola De Luca; Bernard De Bruyne; Emanuele Barbato Journal: High Blood Press Cardiovasc Prev Date: 2022-02-11