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Presence of FFR–negative high-risk non-culprit plaque tied to worse clinical outcomes in patients with MI: JAMA
Netherlands: A recent study published in JAMA Cardiology showed an association between the presence of a fractional flow reserve (FFR)–negative high-risk non-culprit plaque and worse clinical outcomes among patients with myocardial infarction (MI).
The researchers found that MACE (defined as all-cause mortality, unplanned revascularization, and nonfatal MI) occurred in 15% of patients with and 8% without a high-risk plaque after 2 years in the cohort study (PECTUS-obs) involving 420 patients with MI. After adjustment for clinical variables, the presence of a high-risk plaque was tied to a 2-fold increased MACE risk, driven primarily by higher revascularization rates.
Patients with myocardial infarction are known to have high rates of recurrent MACE (major adverse cardiovascular events) even after FFR-guided complete revascularization. These recurrences may be due to 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 MACE occurrence in patients with MI.
PECTUS-obs is a prospective, multicenter, international, observational cohort study. OCT was performed on all FFR-negative (FFR > 0.80) non-culprit lesions in patients presenting with MI. A high-risk plaque was defined as containing at least 2 of the following prespecified criteria: (1) a fibrous cap thickness less than 65 μm, (2) a lipid arc at least 90°, and (3) either plaque rupture or thrombus presence. Patient enrollment was done from 2018 to 2020 and data analysis from 2022 to 2023.
A comparison was drawn for MACE occurrence (primary endpoint) in patients with and without a high-risk plaque, at a 2-year follow-up. A total of 438 patients were enrolled, and OCT findings were analysed in 420. Among the included patients, the mean age was 63 years, 81.0% were men, and STEMI and non-STEMI were equally represented (51.7% and 48.3%).
The study led to the following findings:
- A mean of 1.17 non-culprit lesions per patient was imaged.
- Analysis of OCT images revealed at least 1 high-risk plaque in 143 patients (34.0%).
- 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%).
"To our knowledge, PECTUS-obs is the first prospective cohort study to reveal that the presence of a high-risk plaque is associated with a worse clinical outcome in patients with MI and FFR-negative non-culprit lesions, with a higher number of unplanned revascularization being a primary factor," the researchers wrote.
"In a population with a high recurrent events rate, despite physiology-guided complete revascularization, these results call for research on the potential benefit of additional pharmacological or focal treatment strategies in patients harbouring high-risk plaques," they 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. Published online September 13, 2023. 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