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Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction.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.
Central Illustration
Article online at https://www.sciencedirect.com/science/article/abs/pii/S0735109724068323?via%3Dihub
Section snippets
Study overview
The design and the results of PRE18FFIR have been published previously.12 In brief, PRE18FFIR was a prospective longitudinal cohort study conducted at 9 sites across Australia, England, Scotland, and the United States, enrolling patients aged ?50 years with recent type 1 myocardial infarction and multivessel coronary artery disease between September 2015 and February 2020. Patients were considered to have multivessel coronary artery disease if there was any combination of either of the
Study population
Of 706 patients who underwent coronary 18F-sodium fluoride PET and CTCA, 15 were excluded from the current study because of incomplete data (Figure 1). The study population comprised 691 patients, of whom 414 (60%) had increased total coronary atherosclerotic plaque activity at the patient level. Among 1,258 coronary arteries analyzed in these 414 patients, 679 (54%) had increased coronary atherosclerotic plaque activity.
Baseline vessel characteristics
On CTCA, 2,094 analyzable coronary arteries were identified, of which 832
Discussion
In this secondary vessel-level analysis of PRE18FFIR, we have demonstrated that vessel-specific coronary atherosclerotic plaque activity was associated with myocardial infarction within the same coronary artery territory (Central Illustration) and that increased coronary atherosclerotic plaque activity was predominantly seen in coronary arteries without residual obstructive lesions. Furthermore, patients with multivessel increase in coronary atherosclerotic plaque activity were at the highest
Conclusions
Coronary atherosclerotic plaque activity was independently associated with myocardial infarction at the vessel level and further contributed to estimates of patient-level risk. These findings provide the foundations for strategies to individualize patient risk and enhance preventative treatment using coronary atherosclerotic plaque activity.