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High-risk plaque tied to increased risk of MACE among patients with MI and FFR-negative non-culprit lesions: JAMA
Netherlands: The presence of a fractional flow reserve (FFR)-negative high-risk non-culprit plaque is tied to worse clinical outcomes in patients with myocardial infarction (MI), a recent study published in JAMA Cardiology has suggested.
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
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751