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Multicenter Study
. 2024 Nov 5;13(21):e034458.
doi: 10.1161/JAHA.123.034458. Epub 2024 Oct 22.

Serial Optical Coherence Tomography Assessment of Coronary Atherosclerosis and Long-Term Clinical Outcomes

Kyohei Yamaji  1   2 , Kenji Kanenawa  2 , Toru Morofuji  2 , Ryusuke Nishikawa  1 , Kazuaki Imada  1   2 , Hirohiko Kohjitani  1 , Hiroki Watanabe  3 , Junichi Tazaki  3 , Masanori Taniwaki  4 , Seiji Koga  5 , Ryohei Akashi  5 , Shunsuke Kubo  6 , Masanobu Ohya  6 , Tatsuo Kikuchi  7 , Hiroshi Ohira  7 , Yohei Numasawa  8 , Masaya Arikawa  9 , Makoto Iwama  10 , Takeshi Kitai  11   12 , Yohei Kobayashi  13 , Hiroki Shiomi  1 , Tomohisa Tada  14 , Yuhei Yamaji  15 , Hyuma Daidoji  16 , Hayato Ohtani  17 , Yutaka Furukawa  11 , Kazushige Kadota  6 , Mamoru Toyofuku  3 , Kenji Ando  2 , Koh Ono  1 , Takeshi Kimura  1   18 ; PREDICTOR investigators
Affiliations
Multicenter Study

Serial Optical Coherence Tomography Assessment of Coronary Atherosclerosis and Long-Term Clinical Outcomes

Kyohei Yamaji et al. J Am Heart Assoc. .

Abstract

Background: The impact of high-risk coronary artery plaques identified using optical coherence tomography on late luminal narrowing and clinical events remains poorly understood.

Methods and results: This multicenter prospective study included 176 patients who underwent percutaneous coronary intervention and serial optical coherence tomography at baseline and 1-year follow-up to investigate nontarget regions with angiographically intermediate stenosis. At 1 year after percutaneous coronary intervention, the coronary artery lumen area decreased significantly from 6.06 (95% CI, 5.60-6.53) mm2 to 5.88 (95% CI, 5.41-6.35) mm2 (difference, -0.18; 95% CI, -0.22 to -0.14 mm2; P<0.001), particularly in thin-cap fibroatheromas, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. The prevalence of fibroatheroma decreased from 38% to 36% (P<0.001), whereas calcified plaque increased from 31% to 34% (P<0.001), accompanied by a significant increase in calcium thickness and angle. Diabetes and current smoking habits were independently associated with increasing calcium prevalence. Patients with thin-cap fibroatheroma had a significantly higher 3-year risk of ischemia-driven nontarget vessel revascularization (hazard ratio, 2.42 [95% CI, 1.03-5.71]; P=0.04), primarily due to revascularization in the imaged region. No significant association was observed between coronary artery calcium prevalence and clinical outcomes within 3 years.

Conclusions: The coronary artery lumen area significantly decreased over a 1-year interval, particularly in thin-cap fibroatheromas, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. Although thin-cap fibroatheroma prevalence was associated with higher risk of ischemia-driven nontarget vessel revascularization, no significant association was noted between coronary artery calcium prevalence and clinical outcomes within 3 years. The interaction between calcium progression and long-term clinical events necessitates further investigation.

Registration: URL: https://www.umin.ac.jp/ctr/; Unique Identifier: UMIN000031937.

Keywords: atherosclerotic; coronary artery disease; optical coherence tomography.

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Figures

Figure 1
Figure 1. Study flowchart.
OCT indicates optical coherence tomography.
Figure 2
Figure 2. Image‐level changes in coronary artery plaque phenotypes from baseline to 1‐year follow‐up.
OCT indicates optical coherence tomography.
Figure 3
Figure 3. Image‐level changes in the lumen area from baseline to 1‐year follow‐up according to the coronary artery plaque phenotypes.
Data are shown as values (95% CIs).
Figure 4
Figure 4. Kaplan‐Meier curves for clinical outcomes compared between patients with and without TCFA in the imaged vessels.
Clinical outcomes included (A) all‐cause death, (B) myocardial infarction, (C) any coronary revascularization, (D) target vessel revascularization, (E) nontarget vessel revascularization, and (F) imaged region revascularization. Target vessel revascularization refers to the revascularizations performed in the coronary vessels treated during the baseline procedure. Nontarget vessel revascularization refers to the revascularizations performed in the nonintervened vessels. Imaged region revascularization refers to the revascularizations of lesions located within the regions of interest in the baseline OCT pullbacks. HR indicates hazard ratio; OCT, optical coherence tomography; and TCFA, thin‐cap fibroatheroma.
See this image and copyright information in PMC

Comment in

References

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