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Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study
Aims: Culprit-plaque morphology [plaque rupture (PR) and plaque erosion (PE)] and high-risk plaques (HRP) identified by optical coherence tomography (OCT) and residual SYNTAX score (rSS) have been reported to influence clinical outcomes. Thus, in this study, we aimed to investigate the prognostic im...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Japan Atherosclerosis Society
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9444676/ https://www.ncbi.nlm.nih.gov/pubmed/34544957 http://dx.doi.org/10.5551/jat.63103 |
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author | Wang, Ying Zhao, Xiaoxiao Zhou, Peng Liu, Chen Sheng, Zhaoxue Li, Jiannan Zhou, Jinying Chen, Runzhen Chen, Yi Song, Li Zhao, Hanjun Yan, Hongbing |
author_facet | Wang, Ying Zhao, Xiaoxiao Zhou, Peng Liu, Chen Sheng, Zhaoxue Li, Jiannan Zhou, Jinying Chen, Runzhen Chen, Yi Song, Li Zhao, Hanjun Yan, Hongbing |
author_sort | Wang, Ying |
collection | PubMed |
description | Aims: Culprit-plaque morphology [plaque rupture (PR) and plaque erosion (PE)] and high-risk plaques (HRP) identified by optical coherence tomography (OCT) and residual SYNTAX score (rSS) have been reported to influence clinical outcomes. Thus, in this study, we aimed to investigate the prognostic implication of culprit-plaque morphology and rSS for major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Based on plaque morphology and rSS, 274 STEMI patients were divided into 4 groups: PE/low-rSS (n=61), PE/high-rSS (n=58), PR/low-rSS (n=55), and PR/high-rSS (n=100). According to HRP and rSS, patients were stratified to non-HRP/low-rSS (n=97), non-HRP/high-rSS (n=109), HRP/low-rSS (n=19), and HRP/high-rSS (n=49). MACE was defined as the composite of all-cause death, recurrence of myocardial infarction, stroke, and unplanned revascularization of any coronary artery. Results: During the follow-up of 2.2 years, 47 (17.2%) MACE were observed. Patients with PR/high-rSS and HRP/high-rSS presented lower survival probability on revascularization and MACE. In fully adjusted analyses, PR/high-rSS group presented higher MACE risk than PE/low-rSS (HR: 4.80, 95% CI: 1.43–16.11,P=0.025). Patients with non-HRP/high-rSS (HR: 2.90, 95% CI: 1.01–8.38,P=0.049) and HRP/high-rSS (HR: 8.67, 95% CI: 2.67–28.21,P<0.001) presented higher risk of cardiac events than non-HRP/low-rSS. Adding rSS and HRP to the risk prediction model increased the C-statistic to 0.797 (95% CI: 0.737–0.857), with ΔC-statistic of 0.066 (P=0.002) and the NRI (46.0%, 95% CI: 20.5–56.8%,P<0.001) and IDI (8.7%, 95% CI: 3.6–18.2%,P<0.001). Conclusion: High-risk plaques in combination with rSS enhanced the predictive ability for MACE, indicating culprit-plaque features and residual atherosclerosis burden should be taken into account in risk stratification of STEMI patients. |
format | Online Article Text |
id | pubmed-9444676 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Japan Atherosclerosis Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-94446762022-09-16 Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study Wang, Ying Zhao, Xiaoxiao Zhou, Peng Liu, Chen Sheng, Zhaoxue Li, Jiannan Zhou, Jinying Chen, Runzhen Chen, Yi Song, Li Zhao, Hanjun Yan, Hongbing J Atheroscler Thromb Original Article Aims: Culprit-plaque morphology [plaque rupture (PR) and plaque erosion (PE)] and high-risk plaques (HRP) identified by optical coherence tomography (OCT) and residual SYNTAX score (rSS) have been reported to influence clinical outcomes. Thus, in this study, we aimed to investigate the prognostic implication of culprit-plaque morphology and rSS for major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Based on plaque morphology and rSS, 274 STEMI patients were divided into 4 groups: PE/low-rSS (n=61), PE/high-rSS (n=58), PR/low-rSS (n=55), and PR/high-rSS (n=100). According to HRP and rSS, patients were stratified to non-HRP/low-rSS (n=97), non-HRP/high-rSS (n=109), HRP/low-rSS (n=19), and HRP/high-rSS (n=49). MACE was defined as the composite of all-cause death, recurrence of myocardial infarction, stroke, and unplanned revascularization of any coronary artery. Results: During the follow-up of 2.2 years, 47 (17.2%) MACE were observed. Patients with PR/high-rSS and HRP/high-rSS presented lower survival probability on revascularization and MACE. In fully adjusted analyses, PR/high-rSS group presented higher MACE risk than PE/low-rSS (HR: 4.80, 95% CI: 1.43–16.11,P=0.025). Patients with non-HRP/high-rSS (HR: 2.90, 95% CI: 1.01–8.38,P=0.049) and HRP/high-rSS (HR: 8.67, 95% CI: 2.67–28.21,P<0.001) presented higher risk of cardiac events than non-HRP/low-rSS. Adding rSS and HRP to the risk prediction model increased the C-statistic to 0.797 (95% CI: 0.737–0.857), with ΔC-statistic of 0.066 (P=0.002) and the NRI (46.0%, 95% CI: 20.5–56.8%,P<0.001) and IDI (8.7%, 95% CI: 3.6–18.2%,P<0.001). Conclusion: High-risk plaques in combination with rSS enhanced the predictive ability for MACE, indicating culprit-plaque features and residual atherosclerosis burden should be taken into account in risk stratification of STEMI patients. Japan Atherosclerosis Society 2022-09-01 2021-09-19 /pmc/articles/PMC9444676/ /pubmed/34544957 http://dx.doi.org/10.5551/jat.63103 Text en 2022 Japan Atherosclerosis Society https://creativecommons.org/licenses/by-nc-sa/4.0/This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) |
spellingShingle | Original Article Wang, Ying Zhao, Xiaoxiao Zhou, Peng Liu, Chen Sheng, Zhaoxue Li, Jiannan Zhou, Jinying Chen, Runzhen Chen, Yi Song, Li Zhao, Hanjun Yan, Hongbing Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title | Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title_full | Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title_fullStr | Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title_full_unstemmed | Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title_short | Culprit-Plaque Morphology and Residual SYNTAX Score Predict Cardiovascular Risk in Acute Myocardial Infarction: An Optical Coherence Tomography Study |
title_sort | culprit-plaque morphology and residual syntax score predict cardiovascular risk in acute myocardial infarction: an optical coherence tomography study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9444676/ https://www.ncbi.nlm.nih.gov/pubmed/34544957 http://dx.doi.org/10.5551/jat.63103 |
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