Summary
This international multicentre prospective observational cohort study (PECTUS-obs) enrolled 438 patients presenting with myocardial infarction who underwent OCT imaging of fractional flow reserve-negative nonculprit lesions. Among 420 patients with analysable OCT findings, 143 (34.0%) were found to have at least one high-risk plaque (defined by ≥2 criteria: lipid arc ≥90°, fibrous cap thickness <65 μm, or plaque rupture/thrombus). The study investigated whether these OCT-identified high-risk morphologies in functionally non-significant lesions were associated with subsequent recurrent MACE, addressing a potential gap in current FFR-guided revascularisation strategies.
UK applicability
The findings are applicable to UK cardiology practice, as the study reflects international standards for invasive coronary assessment and optical coherence tomography imaging used in NHS cardiac centres. However, widespread adoption of OCT for all FFR-negative lesions in routine practice would require consideration of NHS resource constraints and health economic evaluation.
Key measures
Optical coherence tomography (OCT)-identified high-risk plaque criteria (lipid arc ≥90°, fibrous cap thickness <65 μm, plaque rupture or thrombus presence); fractional flow reserve (FFR) measurement; major adverse cardiovascular events (MACE) at 2 years; hazard ratios
Outcomes reported
The study assessed the association between optical coherence tomography-identified high-risk plaques in fractional flow reserve-negative nonculprit lesions and the occurrence of major adverse cardiovascular events (MACE) at 2-year follow-up in patients with myocardial infarction. MACE was defined as a composite of all-cause mortality, nonfatal myocardial infarction, or unplanned revascularisation.
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