Prognostic Impact of Healed Coronary Plaque in Non-culprit Lesions Assessed by Optical Coherence Tomography

Background And Aims: We sought to investigate the characteristics and prognostic impact of healed plaque (HP) detected by optical coherence tomography (OCT) in non-culprit segments in treated vessels.

Methods: OCT analysis included HP having a different optical intensity with clear demarcation from underlying plaque, thin-cap fibroatheroma (TCFA), and minimal lumen area. Non-culprit lesion (NCL) was defined as a plaque with >90° arc of disease (≥0.5 mm intimal thickness), length ≥2 mm, and location >5 mm from the stent edges. Major adverse cardiac event (MACE) included cardiac death, myocardial infarction (MI), or ischemia-driven revascularization (IDR).

Results: We studied a total of 726 NCLs in 538 patients who underwent percutaneous coronary intervention with evaluable non-culprit segments by OCT. The prevalence of an HP was 17.8% (129/726) per lesion and 21.9% (118/538) per patient. At median follow-up of 2.2 years, there were 65 NCL-related MACE events, including 6 MIs and 65 IDRs of which 87.7% had a stable presentation. The presence of untreated HP was positively correlated with subsequent NCL-related MACE (hazard ratio [HR] 2.01, 95% confidence interval [CI], 1.20-3.37, p < 0.01). There were 16 IDRs with stable angina occurring at a specific OCT-imaged NCL where an untreated HP was positively associated with subsequent NCL-related MACE (HR 3.72, 95% CI 1.35-10.30, p = 0.01) along with TCFA (HR 10.0, 95% CI 3.20-31.40, p < 0.01) and minimal lumen area <3.5 mm (HR 7.42, 95% CI 2.07-26.60, p < 0.01).

Conclusions: An OCT-detected HP in an NCL is a marker for future (mostly) stable non-culprit-related MACE at both a patient- and lesion-level.