Relationship between pancoronary inflammation and clinical outcome: a 3-vessel OCT study.
The risk of recurrent cardiovascular events remains high in acute myocardial infarction (AMI) patients even after revascularization. Coronary residual inflammation plays a promoting role in this process. This study aimed to address the clinical impact of pancoronary inflammation at long-term follow-up in AMI patients.
Between January 2017 and December 2021, 1312 AMI patients underwent three-vessel optical coherence tomography (OCT) imaging following successful percutaneous coronary intervention. Patients were stratified by the median number (3) of inflammatory plaques (defined as macrophage-containing non-culprit lesions) into low-inflammation (≤3 lesions) and high-inflammation (>3 lesions) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac mortality, non-fatal MI, and unplanned revascularization, assessed over a 5-year follow-up period.
The number of inflammatory plaques (i.e. pancoronary inflammation) had a significant correlation with hs-CRP level (i.e. systemic inflammation) (r = 0.109; P < 0.001). OCT features of plaque vulnerability were significantly more common in patients with high pancoronary inflammation level, compared to those with low pancoronary inflammation level. During a median 4.1-year follow-up, non-culprit lesion-related MACEs occurred more frequently in patients with more inflammatory plaques (8.1% versus 3.1% [hazard ratio, 2.71 (95% CI, 1.52-4.84)]), primarily attributable to increased risk of unplanned coronary revascularization. In multivariable models, higher pancoronary inflammation, rather than higher systemic inflammation, was the independent predictor of non-culprit lesion-related MACEs.
The high pancoronary inflammation was found to be associated with more vulnerable plaque characteristics and increased risk of long-term adverse cardiovascular events in AMI patients.
Between January 2017 and December 2021, 1312 AMI patients underwent three-vessel optical coherence tomography (OCT) imaging following successful percutaneous coronary intervention. Patients were stratified by the median number (3) of inflammatory plaques (defined as macrophage-containing non-culprit lesions) into low-inflammation (≤3 lesions) and high-inflammation (>3 lesions) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac mortality, non-fatal MI, and unplanned revascularization, assessed over a 5-year follow-up period.
The number of inflammatory plaques (i.e. pancoronary inflammation) had a significant correlation with hs-CRP level (i.e. systemic inflammation) (r = 0.109; P < 0.001). OCT features of plaque vulnerability were significantly more common in patients with high pancoronary inflammation level, compared to those with low pancoronary inflammation level. During a median 4.1-year follow-up, non-culprit lesion-related MACEs occurred more frequently in patients with more inflammatory plaques (8.1% versus 3.1% [hazard ratio, 2.71 (95% CI, 1.52-4.84)]), primarily attributable to increased risk of unplanned coronary revascularization. In multivariable models, higher pancoronary inflammation, rather than higher systemic inflammation, was the independent predictor of non-culprit lesion-related MACEs.
The high pancoronary inflammation was found to be associated with more vulnerable plaque characteristics and increased risk of long-term adverse cardiovascular events in AMI patients.
Authors
Zhao Zhao, Cui Cui, Gao Gao, Chen Chen, Zhao Zhao, Ma Ma, Guo Guo, Chen Chen, Dong Dong, Lin Lin, Tan Tan, Wu Wu, Jin Jin, Xiu Xiu, Wang Wang, Li Li, Wang Wang, Xu Xu, Yu Yu, Chen Chen, Hou Hou, Dai Dai, Yu Yu, Fang Fang
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