In JACC. Asia
Background : Artificial intelligence enables simultaneous evaluation of plaque morphology and computational physiology from optical coherence tomography (OCT).
Objectives : This study sought to appraise the predictive value of major adverse cardiovascular events (MACE) by combined plaque morphology and computational physiology.
Methods : A total of 604 patients with acute coronary syndrome who underwent OCT imaging in ≥1 nonculprit vessel during index coronary angiography were retrospectively enrolled. A novel morphologic index, named the lipid-to-cap ratio (LCR), and a functional parameter to evaluate the physiologic significance of coronary stenosis from OCT, namely, the optical flow ratio (OFR), were calculated from OCT, together with classical morphologic parameters, like thin-cap fibroatheroma (TCFA) and minimal lumen area.
Results : The 2-year cumulative incidence of a composite of nonculprit vessel-related cardiac death, cardiac arrest, acute myocardial infarction, and ischemia-driven revascularization (NCV-MACE) at 2 years was 4.3%. Both LCR (area under the curve [AUC]: 0.826; 95% CI: 0.793-0.855) and OFR (AUC: 0.838; 95% CI: 0.806-0.866) were superior to minimal lumen area (AUC: 0.618; 95% CI: 0.578-0.657) in predicting NCV-MACE at 2 years. Patients with both an LCR of >0.33 and an OFR of ≤0.84 had significantly higher risk of NCV-MACE at 2 years than patients in whom at least 1 of these 2 parameters was normal (HR: 42.73; 95% CI: 12.80-142.60; P < 0.001). The combination of thin-cap fibroatheroma and OFR also identified patients at higher risk of future events (HR: 6.58; 95% CI: 2.83-15.33; P < 0.001).
Conclusions : The combination of LCR with OFR permits the identification of a subgroup of patients with 43-fold higher risk of recurrent cardiovascular events in the nonculprit vessels after acute coronary syndrome.
Hong Huihong, Jia Haibo, Zeng Ming, Gutiérrez-Chico Juan Luis, Wang Yini, Zeng Xiaoling, Qin Yuhan, Zhao Chen, Chu Miao, Huang Jiayue, Liu Lili, Hu Sining, He Luping, Chen Lianglong, Wijns William, Yu Bo, Tu Shengxian
2022-Aug
ACS, acute coronary syndrome, AI, artificial intelligence, AUC, area under the curve, FCT, fibrous cap thickness, FFR, fractional flow reserve, LAD, left anterior descending, LCR, lipid-to-cap ratio, MACE, major adverse cardiovascular events, MI, myocardial infarction, MLA, minimal lumen area, NCV-MACE, nonculprit vessel–related major adverse cardiovascular events, OCT, optical coherence tomography, OFR, optical flow ratio, PCI, percutaneous coronary intervention, ROC, receiver-operating characteristic, TCFA, thin-cap fibroatheroma, acute coronary syndrome, coronary physiology, iFR, instantaneous wave-free ratio, optical coherence tomography, optical flow ratio, thin-cap fibroatheroma, vulnerable plaque
