Identifying patients at risk for recurrent events after myocardial infarction

In patients with myocardial infarction, current treatment consists of a coronary angiography (CAG) with subsequent percutaneous coronary intervention (PCI) of the coronary artery lesion responsible for the event. In a large number of cases the CAG shows one or more additional stenoses, that are not responsible for the current event, but could potentially lead to a recurrent cardiovascular event in the future. The decision whether or not to treat these ‘non-culprit lesions’ is currently based on invasive measurements, such as the fractional flow reserve (FFR), assessing the hemodynamic consequence of these lesions. However, recurrent events remain common despite a negative FFR, which would imply low-risk. Therefore, new technologies are warranted that could further help discriminate patients according to their risk of recurrent events. 

In this collaboration between Abbott and the department of cardiology at the Radboud University Medical Center, the value of a relatively new high-resolution imaging modality (optical coherence tomography, OCT) was assessed to this purpose. The hypothesis of this study was that OCT would be able to identify high-risk atherosclerotic plaques that predisposes patients to future cardiovascular events. Identifying these high-risk patients could help guide preventive treatment strategies and thereby improve long-term outcome after myocardial infarction.  

In the prospective PECTUS-obs study, 438 patients presenting with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) underwent OCT of all additional FFR-negative non-culprit lesions. The association between OCT-identified high-risk plaques and clinical outcome was assessed after 2 years. 

After two years of follow-up, the primary clinical endpoint of all-cause mortality, non-fatal myocardial infarction and/or unplanned revascularization occurred in 15% of patients. The presence of a high-risk plaque increased the risk of this endpoint twofold. This effect was independent of traditional risk factors for cardiovascular disease such as diabetes.  

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