Background and aims

Pathologists have shown that intraplaque hemorrhage contributes to plaque destabilization and is frequently co-located with cholesterol crystals (CC). Optical coherence tomography (OCT)-detected low-intensity area without attenuation (LIA) may represent intraplaque hemorrhage. We aimed to examine the prevalence and impact of OCT-detected LIA + CC in untreated non-culprit lesions (NCLs) on subsequent major adverse cardiac events (MACE).

Methods

OCT imaged NCLs in the culprit vessel in the patients who underwent OCT-guided percutaneous coronary intervention were included. An NCL was a lesion with >90° of diseased arc (≥0.5 mm intimal thickness), length ≥2 mm, and >5 mm away from stent edge. CC was defined as a thin linear region of high intensity. NCL-related MACE includes cardiac death, myocardial infarction, or ischemia-driven revascularization attributed to NCLs.

Results

We included 735 NCLs in 566 patients with 2.5 ± 0.7 years follow-up. The prevalence of concomitant LIA with CC (LIA + CC) was 15.5% (114/735). Three-year NCL-related MACE rate was 2.9% (20 events) at a lesion level and 15.6% (78 events) at a patient level. Untreated NCLs with LIA + CC had an increased risk for NCL-MACE (adjusted hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.27–7.50, p = 0.01) along with thin-cap fibroatheroma (adjusted HR 4.38, 95% CI 1.44–13.30, p < 0.01) and minimum lumen area <3.5 mm² (adjusted HR 5.33, 95% CI 1.94–14.62, p < 0.01). Patients having ≥1 untreated NCL with LIA + CC had an increased risk for NCL-MACE (adjusted HR 1.95, 95% CI 1.19–3.19, p < 0.01).

Conclusions

An OCT-detected LIA + CC in an NCL was associated with subsequent NCL-MACE.

中文翻译：

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光学相干断层扫描评估非罪犯病变中无衰减低强度区和胆固醇结晶的临床结果

背景和目标

病理学家已经表明斑块内出血会导致斑块不稳定，并且经常与胆固醇晶体 (CC) 共存。光学相干断层扫描 (OCT) 检测到的无衰减低强度区域 (LIA) 可能代表斑块内出血。我们旨在检查 OCT 检测到的 LIA + CC 在未经治疗的非罪犯病变 (NCL) 中对随后主要不良心脏事件 (MACE) 的影响。

方法

包括接受 OCT 引导的经皮冠状动脉介入治疗的患者的罪犯血管中的 OCT 成像 NCL。NCL是病变弧度>90°（内膜厚度≥0.5mm）、长度≥2mm且距支架边缘>5mm的病变。CC被定义为高强度的薄线性区域。NCL 相关的 MACE 包括心源性死亡、心肌梗死或归因于 NCL 的缺血驱动的血运重建。

结果

我们在 566 名患者中纳入了 735 例 NCL，随访时间为 2.5 ± 0.7 年。伴随 LIA 与 CC (LIA + CC) 的患病率为 15.5% (114/735)。三年 NCL 相关的 MACE 发生率为 2.9%（20 次事件），在病变水平和 15.6%（78 次事件）在患者水平。未经治疗的 LIA + CC NCL 发生 NCL-MACE 的风险增加（调整后的风险比 [HR] 3.09，95% 置信区间 [CI] 1.27-7.50，p  = 0.01）以及薄帽纤维粥样硬化（调整后的 HR 4.38、95 % CI 1.44–13.30，p < 0.01）和最小管腔面积 <3.5 mm ²（调整后的 HR 5.33，95% CI 1.94–14.62，p  < 0.01）。≥1 处未治疗 NCL 伴 LIA + CC 的患者发生 NCL-MACE 的风险增加（调整后的 HR 1.95，95% CI 1.19–3.19，p  < 0.01）。

结论

NCL 中 OCT 检测到的 LIA + CC 与随后的 NCL-MACE 相关。