High-risk plaque tied to increased risk of MACE among patients with MI and FFR-negative non-culprit lesions: JAMA

In the cohort study of 420 patients with MI, MACE (defined as nonfatal MI, all-cause mortality, and unplanned revascularization) occurred in 15% of the patients with and 8% without a high-risk plaque after 2 years.

"After adjustment for clinical variables, the presence of a high-risk plaque was associated with a 2-fold increased risk of major adverse cardiovascular events (MACE), driven primarily by higher revascularization rates," the researchers reported in the PECTUS-obs trial.

Even after FFR-guided complete revascularization, patients with MI have high rates of recurrent MACE. These recurrences may be caused by FFR-negative high-risk non-culprit lesions. Jan-Quinten Mol, Radboud University Medical Center, Nijmegen, the Netherlands, and colleagues aimed to assess the association between optical coherence tomography (OCT)-identified high-risk plaques of FFR-negative non-culprit lesions and occurrence of MACE in MI patients.

PECTUS-obs is a multicenter, international, prospective, observational cohort study. OCT was performed on all FFR-negative (FFR > 0.80) non-culprit lesions in patients presenting with MI enrolled from 2018 to 2020.

The primary endpoint of MACE was compared in patients with and without a high-risk plaque.

The researchers reported the following findings:

• A total of 438 patients were enrolled, and OCT findings were analysed in 420. Among the included patients, the mean age was 63 years, 340 were men, and STEMI and non-STEMI were equally represented (51.7% and 48.3%). A mean of 1.17 non-culprit lesions per patient was imaged.
• Analysis of OCT images revealed at least 1 high-risk plaque in 34.0% of patients.
• The primary endpoint occurred in 15.4% of patients with a high-risk plaque and 8.3% of patients without a high-risk plaque (hazard ratio, 1.93), primarily driven by more unplanned revascularizations in patients with a high-risk plaque (9.8% versus 4.3%).

The presence of a high-risk plaque is tied to a worse clinical outcome among patients with MI and FFR-negative non-culprit lesions, mainly driven by a higher number of unplanned revascularization.

"These results call for research on additional pharmacological or focal treatment strategies in patients harbouring high-risk plaques in a population with a high recurrent event rate despite physiology-guided complete revascularization," the researchers concluded.

Reference:

Mol J, Volleberg RHJA, Belkacemi A, et al. Fractional Flow Reserve–Negative High-Risk Plaques and Clinical Outcomes After Myocardial Infarction. JAMA Cardiol. 2023;8(11):1013–1021. doi:10.1001/jamacardio.2023.2910