After a myocardial infarction (MI), non-culprit lesions are often deferred when they are not flow-limiting (negative FFR). However, these lesions continue to represent an important source of recurrent cardiovascular events. The presence of high-risk plaques (HRP), identified by optical coherence tomography (OCT) in lesions with negative FFR, has been associated with worse long-term clinical outcomes.
The aim of this prospective, observational, multicenter study was to evaluate the association between HRP and cardiovascular events after MI during a 5-year follow-up period.
A total of 438 patients with recent MI (STEMI or NSTEMI) were included. OCT was performed in all intermediate non-culprit lesions (30–90% visual stenosis) with an FFR >0.80. HRP was defined according to OCT criteria as the presence of at least two of the following three features: lipid arc ≥90°, minimum fibrous cap thickness <65 µm, and plaque rupture or thrombus.
The primary endpoint (PEP) was patient-level major adverse cardiovascular events (MACE), defined as cardiac death, non-fatal MI, or unplanned revascularization at 5 years.
The prevalence of HRP was 34% (143 out of 420 analyzed patients). Regarding outcomes, the MACE rate was significantly higher in the HRP group compared with patients without HRP (18.9% vs. 10.8%; HR 1.87; 95% CI: 1.11–3.14; p=0.017).
When analyzing the individual components of the primary endpoint, the risk of non-fatal MI was four times higher in patients with HRP (HR 4.07; p=0.013), while the need for unplanned revascularization was nearly doubled (HR 1.97; p=0.027).
The risk associated with HRP was mainly concentrated within the first two years of follow-up (HR 2.67; p=0.006). Between years 2 and 5, the difference was no longer statistically significant (HR 1.25; p=0.581). Among the OCT findings, non-culprit plaque rupture showed the strongest association with adverse outcomes (HR 3.20 for MACE; p<0.001).
OCT-Detected High-Risk Plaques Increase MACE Risk After Myocardial Infarction Despite Negative FFR
High-risk non-culprit plaques, even in the absence of significant flow limitation, are associated with an increased risk of long-term adverse clinical events after myocardial infarction. OCT identification of these plaques allows the detection of a higher-risk population that may benefit from more intensive therapeutic strategies.
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