Coronary atherosclerotic plaque activity not associated with cardiac death, nonfatal MI or revascularization

New research revealed that in patients with recent myocardial infarction coronary atherosclerotic plaque activity was not associated with cardiac death, nonfatal myocardial infarction, or revascularization. The study results were published in JAMA Cardiology. 

Patients with recent myocardial infarction still experience recurrent coronary episodes, which can be a significant clinical issue. Individuals at risk can be identified using noninvasive indicators of coronary atherosclerotic disease activity. There is a high necessity to detect high-risk coronary artery plaques that drive downstream events and identify patients at risk of future coronary events. Many techniques have been developed that are invasive and impractical for widespread application. Hence researchers conducted a prospective, longitudinal, international multicenter cohort study to assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction. 

Participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020 were identified and followed up for two years. Coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography were used. 18F-sodium fluoride uptake was used to assess the total coronary atherosclerotic plaque activity. Measuring cardiac death or any nonfatal myocardial infarctions, and any unscheduled coronary revascularization due to lower-than-anticipated primary event rates were the primary endpoints. 

Key findings: 

• Among 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population.
• The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]).
• About 421 participants (60%) showed total coronary atherosclerotic plaque activity.
• Among the 141 participants (20%) who experienced the primary endpoint: 9 had cardiac death, 49 had a nonfatal myocardial infarction, and 83 had unscheduled coronary revascularization, after a median follow-up of 4 years (IQR, 3-5 years),
• Increased coronary plaque activity was not associated with the primary endpoint or unscheduled revascularization but was associated with the secondary endpoint of cardiac death or nonfatal myocardial infarction and all-cause mortality.
• After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction but not with all-cause mortality. 

Thus, coronary atherosclerotic plaque activity was not associated with the primary composite end point of cardiac death, nonfatal MI, or unplanned revascularization. But plaque activity appeared to be associated with combined cardiac death and MI in secondary analysis, thus warranting further study. 

Further reading: Moss A, Daghem M, Tzolos E, et al. Coronary Atherosclerotic Plaque Activity and Future Coronary Events. JAMA Cardiol. Published online June 28, 2023. doi:10.1001/jamacardio.2023.1729