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Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial Infarction : A Prospect II Substudy

Arslani, Ketina ; Engstrøm, Thomas LU ; Maeng, Michael ; Kjøller-Hansen, Lars ; Maehara, Akiko ; Zhou, Zhipeng ; Ben-Yehuda, Ori ; Bøtker, Hans Erik ; Matsumura, Mitsuaki and Mintz, Gary S. , et al. (2025) In JACC: Cardiovascular Imaging 18(6). p.696-706
Abstract

Background: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions. Objectives: The authors aimed to assess whether pressure-wire–based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics. Methods: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%. Results: Among... (More)

Background: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions. Objectives: The authors aimed to assess whether pressure-wire–based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics. Methods: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis >40%. Results: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm2 (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not. Conclusions: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute myocardial infarction, coronary physiology, intravascular imaging, vulnerable plaque
in
JACC: Cardiovascular Imaging
volume
18
issue
6
pages
11 pages
publisher
Elsevier
external identifiers
  • pmid:39998456
  • scopus:85218883000
ISSN
1936-878X
DOI
10.1016/j.jcmg.2024.11.002
language
English
LU publication?
yes
id
441ade8b-9bd2-47c7-82a1-60747ab46dae
date added to LUP
2025-07-01 09:24:31
date last changed
2025-07-01 09:25:50
@article{441ade8b-9bd2-47c7-82a1-60747ab46dae,
  abstract     = {{<p>Background: Hemodynamically obstructive coronary plaques may contain more vulnerable plaque characteristics than nonobstructive lesions. Objectives: The authors aimed to assess whether pressure-wire–based physiologic indices in nonculprit lesions are associated with vulnerable plaque characteristics. Methods: In the PROSPECT II study, patients with recent myocardial infarction underwent coronary angiography and culprit lesion percutaneous coronary intervention plus combined near-infrared spectroscopy and intravascular ultrasound assessment of all 3 coronary arteries. Instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements were performed in intermediate lesions with angiographic stenosis &gt;40%. Results: Among 898 patients, 319 angiographically intermediate lesions in 275 patients had matched intravascular ultrasound/near-infrared spectroscopy and FFR/iFR measurements; 96 (30.1%) lesions were physiologically significant (FFR ≤0.80 or iFR ≤0.89) and 223 (69.9%) were not. Physiologically significant lesions, compared with those that were not, more likely had a minimal lumen area ≤4.0 mm<sup>2</sup> (96.9% vs 83.9%), plaque burden ≥70% (92.7% vs 71.3%) and maximum lipid core burden index in any 4 mm segment of the lesion ≥324.7 (57.0% vs 45.4%). By multivariable analysis, lesion location in the left anterior descending artery, small minimal lumen area, and larger plaque burden were independently associated with physiologic significance, whereas maximum lipid core burden index in any 4 mm segment of the lesion was not. Conclusions: In patients with recent myocardial infarction, angiographically intermediate but physiologically significant coronary lesions were more likely to have high-risk vulnerable plaque features compared with nonphysiologically significant stenoses. However, coronary lesions without physiological significance also had a moderate-to-high prevalence of high-risk plaque characteristics, which may explain the residual risk associated with conservative noninterventional management of these lesions.</p>}},
  author       = {{Arslani, Ketina and Engstrøm, Thomas and Maeng, Michael and Kjøller-Hansen, Lars and Maehara, Akiko and Zhou, Zhipeng and Ben-Yehuda, Ori and Bøtker, Hans Erik and Matsumura, Mitsuaki and Mintz, Gary S. and Fröbert, Ole and Persson, Jonas and Wiseth, Rune and Larsen, Alf I. and Jensen, Lisette O. and Nordrehaug, Jan E. and Bleie, Øyvind and Omerovic, Elmir and Held, Claes and James, Stefan K. and Ali, Ziad A. and Erlinge, David and Stone, Gregg W.}},
  issn         = {{1936-878X}},
  keywords     = {{acute myocardial infarction; coronary physiology; intravascular imaging; vulnerable plaque}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{696--706}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Imaging}},
  title        = {{Association Between Physiological Significance and Vulnerable Plaque Characteristics in Patients With Myocardial Infarction : A Prospect II Substudy}},
  url          = {{http://dx.doi.org/10.1016/j.jcmg.2024.11.002}},
  doi          = {{10.1016/j.jcmg.2024.11.002}},
  volume       = {{18}},
  year         = {{2025}},
}