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COMPLETE OCT: Nearly half of patients with obstructive nonculprit lesions have vulnerable plaque
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PHILADELPHIA — In an OCT substudy of the COMPLETE trial, researchers determined that 47% of patients had obstructive nonculprit lesions with vulnerable plaque, which could explain why complete revascularization conferred better outcomes than culprit lesion-only revascularization in the main trial.
As Healio previously reported, in the main results of COMPLETE, patients with STEMI and multivessel CAD who underwent complete revascularization had lower risk for CV death/new MI and CV death/new MI/ischemia-driven revascularization. Natalia Pinilla-Echeverri, MD, MSc, assistant professor of medicine at McMaster University, presented the OCT substudy results at the American Heart Association Scientific Sessions.
“Whether the benefit of routine nonculprit-lesion PCI might be associated with vulnerable plaque morphology is unclear,” she said during the presentation, noting that the researchers determined vulnerable plaque by OCT assessment of thin-cap fibro atheroma, a well-known feature of vulnerable plaque.
The researchers imaged 93 patients (mean age, 61 years; 83% men), 66 of whom were assigned complete revascularization in COMPLETE and the rest of whom were planned for nonculprit lesion PCI.
The prevalence of thin-cap fibro atheroma per lesion was 35.4% in obstructive lesions and 23.2% in nonobstructive lesions (P = .022), Pinilla-Echeverri said.
In obstructive lesions, those with thin-cap fibro atheroma were similar in length and lumen area to those without obstructive lesions, but there were more lipid, fibrous and calcium features. In lesions with thin-cap fibro atheroma, the obstructive lesions were longer and had a smaller minimum lumen area than nonobstructive lesions, but had similar plaque composition, she said.
Among patients in the cohort, 47.3% had an obstructive nonculprit lesion with vulnerable plaque, 20.4% had a nonobstructive nonculprit lesion with vulnerable plaque and 32.3% had no nonculprit lesions with vulnerable plaque, according to the researchers.
“In patients with STEMI and multivessel coronary artery disease, half of patients had a nonculprit lesion with vulnerable plaque morphology by OCT,” Pinilla-Echeverri said during the presentation. “Obstructive lesions more commonly harbor vulnerable plaque morphology than nonobstructive lesions. This may explain the benefit of routine PCI of obstructive nonculprit lesions in patients with STEMI and multivessel disease.” – by Erik Swain
Reference:
Pinilla-Echeverri N., et al. Late Breaking Science IV: State of the Art Interventional Management for ACS Patients. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: The study was funded in part by Abbott Vascular. Pinilla-Echeverri reports she received personal fees from Abbott and Conavi.
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Dharam J. Kumbhani, MD, SM
This was an interesting analysis in a small population. It mechanistically confirms what we now seem to think about why the biology of why multivessel PCI may be beneficial in patients with STEMI who are not in cardiogenic shock. There are likely more unstable lesions than can be detected angiographically. It was helpful to corroborate that, even if it was in a small subset.
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