Non-culprit plaque healing on serial OCT imaging and future outcome in patients with acute coronary syndromes

Boling Yi, Luping He, Dirui Zhang, Ming Zeng, Chen Zhao, Wei Meng, Yuhan Qin, Ziqian Weng, Yishuo Xu, Minghao Liu, Xi Chen, Shuangtong Shao, Qianhui Sun, Wentao Wang, Man Li, Yin Lv, Xing Luo, Xiaoxuan Bai, Xiuzhu Weng, Jason L JohnsonThomas W Johnson, Giulio Guagliumi, Sining Hu*, Bo Yu*, Haibo Jia*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background and aims
Histologic studies indicated that healed plaque, characterized by a multilayered pattern, is indicative of prior atherothrombosis and subsequent healing. However, longitudinal in vivo data on healed plaque formation in non-culprit plaques are limited. This study aimed to investigate serial changes and clinical significance of new layered pattern formation in non-culprit plaques in patients with acute coronary syndromes (ACS) using serial optical coherence tomography (OCT) imaging.

Methods
ACS patients who underwent two OCTs at baseline and 1-year follow-up were included. Serial changes in morphologic characteristics of non-culprit plaques were evaluated. New layered pattern was defined as a new signal-rich layer on the plaque surface at follow-up that was not present at baseline.

Results
Among 553 non-culprit plaques observed in 222 patients, 82 (14.8 %) exhibited a new layered pattern at follow-up. Thin-cap fibroatheroma, macrophage, and thrombus were identified as independent predictors of the new layered pattern. Plaques with new layered pattern formation showed a greater significant reduction in luminal area and lipid content, as well as a greater increase in fibrous cap thickness compared to those without. The incidence of 6-year non-culprit-related major adverse cardiac events was higher in patients with new layered pattern than in those without (25.4 % vs. 10.8 %, p = 0.011), mainly due to clinically driven coronary revascularization.

Conclusions
Plaque destabilization and subsequent healing frequently occur in non-culprit plaques after ACS. The formation of a new layered pattern may contribute to temporary plaque stabilization, but results in luminal stenosis and worse clinical outcomes.
Original languageEnglish
Article number119092
Number of pages8
JournalAtherosclerosis
Volume401
Early online date11 Dec 2024
DOIs
Publication statusPublished - 1 Feb 2025

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Publisher Copyright:
© 2024 Elsevier B.V.

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