Identification of High-Risk Coronary Lesions by 3-Vessel Optical Coherence Tomography
Authors' conclusion
OCT imaging of angiographically nonobstructive territories in patients with acute MI can aid in identifying patients and lesions at increased risk for adverse cardiac events.
Study context
- Population
- Patients with acute myocardial infarction (MI) referred for primary PCI, 3-vessel optical coherence tomography (OCT), January 2017–May 2019
- Participants
- 883 patients
- Outcome
- Composite of:
- Cardiac death
- Nonculprit lesion-related nonfatal MI
- Unplanned coronary revascularization
- Follow-up
- Up to 4 years (median 3.3 years)
Methodological details3-vessel OCT
- 3-vessel OCT
Main finding
As reported in the abstract
Primary endpoint · up to 4 years
- 4-year cumulative rate of primary endpoint
- 7.2%
- Patient level: Thin-cap fibroatheroma (TCFA), adjusted HR
- 3.05 (95% CI 1.67-5.57)
- Patient level: Minimal lumen area (MLA) <3.5 mm², adjusted HR
- 3.71 (95% CI 1.22-11.34)
- Lesion level: TCFA, adjusted HR
- 8.15 (95% CI 3.67-18.07)
- Lesion level: MLA <3.5 mm², adjusted HR
- 4.33 (95% CI 1.81-10.38)
Observational data: associations, not effects.
Further findings
Baseline diameter stenosis of nonculprit lesions responsible for subsequent events
- Not angiographically severe; mean diameter stenosis (SD 13.4%)
- 43.8%
TCFA with MLA <3.5 mm²; cardiac death and nonculprit lesion-related nonfatal MI
- Higher risk; sufficient for identifying patients at risk
Original publication
Identification of High-Risk Coronary Lesions by 3-Vessel Optical Coherence Tomography. J Am Coll Cardiol. Published 14 March 2023. doi:10.
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