دورية أكاديمية
Fractional Flow Reserve-Negative High-Risk Plaques and Clinical Outcomes After Myocardial Infarction.
| العنوان: | Fractional Flow Reserve-Negative High-Risk Plaques and Clinical Outcomes After Myocardial Infarction. |
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| المؤلفون: | Mol JQ; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands., Volleberg RHJA; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands., Belkacemi A; Department of Cardiology, AZ West Hospital, Veurne, Belgium., Hermanides RS; Department of Cardiology, Isala Hospital, Zwolle, the Netherlands., Meuwissen M; Department of Cardiology, Amphia Hospital, Breda, the Netherlands., Protopopov AV; Cardiovascular Center of Regional State Hospital, Krasnoyarsk, Russia., Laanmets P; Cardiology Center, North Estonia Medical Center, Tallinn, Estonia., Krestyaninov OV; Meshalkin National Medical Research Center, Novosibirsk, Russia., Dennert R; Department of Cardiology, Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba., Oemrawsingh RM; Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands., van Kuijk JP; Department of Cardiology, Sint Antonius Hospital, Nieuwegein, the Netherlands., Arkenbout K; Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands., van der Heijden DJ; Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.; Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands., Rasoul S; Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands.; Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands., Lipsic E; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands., Rodwell L; Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands., Camaro C; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands., Damman P; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands., Roleder T; Department of Cardiology, Regional Specialist Hospital, Wrocław, Poland., Kedhi E; Department of Cardiology, Erasmus Hospital, Université libre de Bruxelles, Brussels, Belgium., van Leeuwen MAH; Department of Cardiology, Isala Hospital, Zwolle, the Netherlands., van Geuns RM; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands., van Royen N; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. |
| المصدر: | JAMA cardiology [JAMA Cardiol] 2023 Nov 01; Vol. 8 (11), pp. 1013-1021. |
| نوع المنشور: | Observational Study; Multicenter Study; Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101676033 Publication Model: Print Cited Medium: Internet ISSN: 2380-6591 (Electronic) NLM ISO Abbreviation: JAMA Cardiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Chicago, Illinois] : American Medical Association, [2016]- |
| مواضيع طبية MeSH: | Fractional Flow Reserve, Myocardial* , ST Elevation Myocardial Infarction*/therapy , Percutaneous Coronary Intervention*/methods , Myocardial Infarction*/epidemiology , Plaque, Atherosclerotic*/diagnostic imaging, Male ; Humans ; Middle Aged ; Female ; Prospective Studies |
| مستخلص: | Importance: Even after fractional flow reserve (FFR)-guided complete revascularization, patients with myocardial infarction (MI) have high rates of recurrent major adverse cardiovascular events (MACE). These recurrences may be caused by FFR-negative high-risk nonculprit lesions. Objective: To assess the association between optical coherence tomography (OCT)-identified high-risk plaques of FFR-negative nonculprit lesions and occurrence of MACE in patients with MI. Design, Setting, and Participants: PECTUS-obs (Identification of Risk Factors for Acute Coronary Events by OCT After STEMI [ST-segment elevation MI] and NSTEMI [non-STEMI] in Patients With Residual Non-flow Limiting Lesions) is an international, multicenter, prospective, observational cohort study. In patients presenting with MI, OCT was performed on all FFR-negative (FFR > 0.80) nonculprit lesions. A high-risk plaque was defined containing at least 2 of the following prespecified criteria: (1) a lipid arc at least 90°, (2) a fibrous cap thickness less than 65 μm, and (3) either plaque rupture or thrombus presence. Patients were enrolled from December 14, 2018, to September 15, 2020. Data were analyzed from December 2, 2022, to June 28, 2023. Main Outcome and Measure: The primary end point of MACE, a composite of all-cause mortality, nonfatal MI, or unplanned revascularization, at 2-year follow-up was compared in patients with and without a high-risk plaque. Results: A total of 438 patients were enrolled, and OCT findings were analyzable in 420. Among included patients, mean (SD) age was 63 (10) years, 340 (81.0) were men, and STEMI and non-STEMI were equally represented (217 [51.7%] and 203 [48.3%]). A mean (SD) of 1.17 (0.42) nonculprit lesions per patient was imaged. Analysis of OCT images revealed at least 1 high-risk plaque in 143 patients (34.0%). The primary end point occurred in 22 patients (15.4%) with a high-risk plaque and 23 of 277 patients (8.3%) without a high-risk plaque (hazard ratio, 1.93 [95% CI, 1.08-3.47]; P = .02), primarily driven by more unplanned revascularizations in patients with a high-risk plaque (14 of 143 [9.8%] vs 12 of 277 [4.3%]; P = .02). Conclusions and Relevance: Among patients with MI and FFR-negative nonculprit lesions, the presence of a high-risk plaque is associated with a worse clinical outcome, which is mainly driven by a higher number of unplanned revascularizations. In a population with a high recurrent event rate despite physiology-guided complete revascularization, these results call for research on additional pharmacological or focal treatment strategies in patients harboring high-risk plaques. |
| تواريخ الأحداث: | Date Created: 20230913 Date Completed: 20231109 Latest Revision: 20231206 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC10500430 |
| DOI: | 10.1001/jamacardio.2023.2910 |
| PMID: | 37703036 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2380-6591 |
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| DOI: | 10.1001/jamacardio.2023.2910 |