Highlights from

AHA 2019

American Heart Association’s Scientific Sessions

Philadelphia, USA 16 - 18 November 2019

Obstructive Nonculprit Lesions with Vulnerable Plaque Key Revascularisation Benefit

Prof. Natalia Pinilla-Echeverri (McMaster University, Canada) presented the results of an Optical Coherence Tomography (OCT) substudy of the COMPLETE trial, which determined that 47% of patients had obstructive nonculprit lesions with vulnerable plaque, which could explain why complete revascularisation conferred better outcomes than culprit lesion-only revascularisation in the main trial [1].

The main results of COMPLETE reported that patients with ST segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease who underwent complete revascularisation had lower risk for cardiovascular (CV) death/new myocardial infarction (MI) and CV death/new MI/ischaemia-driven revascularisation.

“Whether the benefit of routine nonculprit-lesion percutaneous coronary intervention 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% male), 66 of whom were assigned complete revascularisation in COMPLETE, and the rest of whom were planned for nonculprit-lesion percutaneous coronary intervention.

The prevalence of thin-cap fibro atheroma per lesion was 35.4% in obstructive lesions and 23.2% in nonobstructive lesions (P=0.022). In obstructive lesions, those with thin-cap fibro atheroma were similar in length and lumen area to those without obstructive lesions, but there was more lipid present as well as 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 showed similar plaque composition.

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. These features of vulnerable plaques are thought to be largely attributable to the results observed in the COMPLETE trial.

  1. Pinilla-Echeverri N, et al. OCT COMPLETE: Non-culprit Lesion Plaque Morphology in Patients with ST-segment Elevation Myocardial Infarction: Substudy from the Complete Trial using Optical Coherence Tomography (OCT). Session LBS04. American Heart Association Annual Scientific Sessions (AHA 2019), 14-18 November, Philadelphia, PA, USA.

Top image: @ iStockPhoto: Noctiluxx

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