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Multicenter Study
. 2024 Jun 4;83(22):2135-2144.
doi: 10.1016/j.jacc.2024.03.419.

Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction

Kang-Ling Wang  1 , Craig Balmforth  2 , Mohammed N Meah  2 , Marwa Daghem  2 , Alastair J Moss  2 , Evangelos Tzolos  2 , Jacek Kwiecinski  3 , Patrycja Molek-Dziadosz  4 , Neil Craig  2 , Anda Bularga  2 , Philip D Adamson  5 , Dana K Dawson  6 , Parthiban Arumugam  7 , Nikant K Sabharwal  8 , John P Greenwood  9 , Jonathan N Townend  10 , Patrick A Calvert  11 , James H F Rudd  12 , Johan W Verjans  13 , Daniel S Berman  14 , Piotr J Slomka  14 , Damini Dey  14 , Nicholas L Mills  2 , Edwin J R van Beek  2 , Michelle C Williams  2 , Marc R Dweck  2 , David E Newby  2 ; PRE(18)FFIR Study Investigators
Affiliations
Multicenter Study

Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction

Kang-Ling Wang et al. J Am Coll Cardiol. .

Abstract

Background: Total coronary atherosclerotic plaque activity across the entire coronary arterial tree is associated with patient-level clinical outcomes.

Objectives: We aimed to investigate whether vessel-level coronary atherosclerotic plaque activity is associated with vessel-level myocardial infarction.

Methods: In this secondary analysis of an international multicenter study of patients with recent myocardial infarction and multivessel coronary artery disease, we assessed vessel-level coronary atherosclerotic plaque activity using coronary 18F-sodium fluoride positron emission tomography to identify vessel-level myocardial infarction.

Results: Increased 18F-sodium fluoride uptake was found in 679 of 2,094 coronary arteries and 414 of 691 patients. Myocardial infarction occurred in 24 (4%) vessels with increased coronary atherosclerotic plaque activity and in 25 (2%) vessels without increased coronary atherosclerotic plaque activity (HR: 2.08; 95% CI: 1.16-3.72; P = 0.013). This association was not demonstrable in those treated with coronary revascularization (HR: 1.02; 95% CI: 0.47-2.25) but was notable in untreated vessels (HR: 3.86; 95% CI: 1.63-9.10; Pinteraction = 0.024). Increased coronary atherosclerotic plaque activity in multiple coronary arteries was associated with heightened patient-level risk of cardiac death or myocardial infarction (HR: 2.43; 95% CI: 1.37-4.30; P = 0.002) as well as first (HR: 2.19; 95% CI: 1.18-4.06; P = 0.013) and total (HR: 2.50; 95% CI: 1.42-4.39; P = 0.002) myocardial infarctions.

Conclusions: In patients with recent myocardial infarction and multivessel coronary artery disease, coronary atherosclerotic plaque activity prognosticates individual coronary arteries and patients at risk for myocardial infarction.

Keywords: coronary atherosclerotic plaque activity; myocardial infarction; positron emission tomography.

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Conflict of interest statement

Funding Support and Author Disclosures The PRE(18)FFIR study was funded by the Wellcome Trust (WT103782AIA). The funder played no roles in the design and conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript, and any decisions to submit the manuscript for publication. The University of Edinburgh and the National Health Service Lothian Health Board were cosponsors. Dr Rudd is part-supported by the National Institute for Health and Care Research Cambridge Biomedical Research Centre, the British Heart Foundation, the Higher Education Funding Council for England, the Engineering and Physical Sciences Research Council, and the Wellcome Trust. Dr Piotr is supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (R35HL161195). Dr Mills is supported by the British Heart Foundation (CH/F/21/90010, RE/18/5/34216, and RG/20/10/34966). Dr van Beek is supported by the Scottish Imaging Network. Dr Williams is supported by the British Heart Foundation (FS/ICRF/20/26002). Dr Dweck is supported by the British Heart Foundation (FS/SCRF/21/32010). Dr Newby is supported by the British Heart Foundation (CH/09/002, RE/18/5/34216, and RG/F/22/110093). Dr Moss is a current employee of AstraZeneca. Dr Williams has given talks for Canon Medical Systems, Novartis, and Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Study flowchart.
Sub-study population from the PRE18FFIR study and the distribution of coronary arteries with and without increased coronary atherosclerotic plaque activity. CTCA = computed tomography coronary angiography; PET = positron emission tomography
Figure 2.
Figure 2.. Cumulative incidence of myocardial infarction.
Time-to-first event of vessel-level myocardial infarction according to the presence or absence of increased coronary atherosclerotic plaque activity.
Figure 3.
Figure 3.. Impact of coronary revascularization on myocardial infarction.
Cumulative incidence of myocardial infarction for coronary arteries that (A) had or (B) had not been treated with coronary revascularization prior to baseline imaging. Index coronary revascularization had a differential effect on the relationship between coronary atherosclerotic plaque activity and myocardial infarction. CI = confidence interval; HR = hazard ratio
Figure 4.
Figure 4.. Patient-level events.
Cumulative incidence of (A) cardiac death or myocardial infarction, (B) first myocardial infarction, and (C) total myocardial infarctions (shown as the mean cumulative count per 100 patients) across the number of coronary arteries with increased coronary atherosclerotic plaque activity. CI = confidence interval; HR = hazard ratio
See this image and copyright information in PMC

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