Coronary disease & ACSCohort study
Long-Term Prognostic Implications of Non-Culprit Lesions in Patients Presenting With an Acute Myocardial Infarction: Is It the Angiographic Stenosis Severity or the Underlying High-Risk Morphology?
- Prospective cohort study
Authors' conclusion
The long-term prognostic implications of the presence and extent of angiographic obstructive non-culprit lesions in patients with acute myocardial infarction are primarily due to their correlation with the underlying high-risk morphology, which confers an increased risk of recurrent MACEs.
Study context
- Population
- Patients with acute MI undergoing OCT of all 3 main epicardial arteries after successful PCI, 2017–2021
- Participants
- 1,312 patients
- Exposure
- Obstructive non-culprit lesions vs none; Thin-cap fibroatheroma (TCFA) vs no TCFA
- Obstructive non-culprit lesionsn = 492
- Outcome
- MACE:
- Cardiac death
- Non-fatal MI
- Unplanned coronary revascularization
- Follow-up
- Up to 5 years (median 4.1 [IQR 3.0-5.0] years)
Main finding
Overall MACE
Hazard ratio
1.39
95% CI 1.02–1.91
By group
Obstructive non-culprit lesions vs No obstructive non-culprit lesions
HR 1.39 (95% CI 1.02–1.91)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Obstructive non-culprit lesions | No obstructive non-culprit lesions | HR (95% CI) | |
|---|---|---|---|---|
| Non-culprit lesion-related MACE | 8.7% | 3.9% | 2.13 (1.26–3.59) | |
| Lesion-level MACE — Obstructive lesion vs No obstructive non-culprit lesions · lesion-specific | 2.03 (1.06–3.89) | |||
| Lesion-level MACE — TCFA vs No obstructive non-culprit lesions · lesion-specific | 2.39 (1.29–4.43) | |||
| 0.20.5125Hazard ratio (log scale) |
Lesion-level MACE
- TCFA prevalence twice as high in obstructive vs nonobstructive lesions
Original publication
Long-Term Prognostic Implications of Non-Culprit Lesions in Patients Presenting With an Acute Myocardial Infarction: Is It the Angiographic Stenosis Severity or the Underlying High-Risk Morphology? Circulation. Published 31 January 2025. doi:10.1161/circulationaha.124.071855
Summarised from the published abstract; every number is checked against it