Relationship among clinical characteristics, morphological culprit plaque features, and long-term prognosis in patients with acute coronary syndrome

Development of a multidimensional prediction model for long-term prognostic risk in patients with acute coronary syndromes after percutaneous coronary intervention: A retrospective observational cohort study

BACKGROUND

The aim of this study is to examine the critical variables that impact the long-term prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and to create a multidimensional predictive risk assessment model that can serve as a theoretical basis for accurate cardiac rehabilitation.

METHODS

The study involved ACS patients who received PCI at the First Hospital of Jilin University from June 2020 to March 2021. Participants were categorized into two groups: acute myocardial infarction (AMI) and unstable angina (UA), according to clinical data and angiographic findings. Hospitalization data, physical performance, exercise tolerance prior to discharge, average daily steps, major adverse cardiac events (MACE), and a follow-up period of 36 months were documented. The dates for accessing data for research purposes are February 10, 2022 (10/2/2022) to December 10, 2023 (10/12/2023).

RESULTS

We observed substantial increases in weight, fasting plasma glucose (FPG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), white blood cell (WBC) count, neutrophil granulocyte count, monocyte count, hemoglobin (Hb) levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels in the acute myocardial infarction (AMI) cohort relative to the unstable angina (UA) cohort. We found white blood cell count (WBC) (OR: 4.110) and the effective average number of daily steps (ANS) (OR: 2.689) as independent prognostic risk factors for acute myocardial infarction (AMI). The independent risk factors for unstable angina prognosis were white blood cell count (OR: 6.257), VO2 at anaerobic threshold (OR: 4.294), and effective autonomic nervous system function (OR: 4.097). The whole prognostic risk assessment score for acute myocardial infarction (AMI) is 5 points, with 0 points signifying low risk, 2-3 points representing intermediate risk, and 5 points indicating high risk. The overall prognostic risk assessment score for UA is 7 points, with 0-3 classified as low risk, 4-5 as intermediate risk, and 6-7 as high risk.

CONCLUSION

This study developed a multimodal predictive model that integrates the inflammatory response after onset, physical performance and exercise tolerance before discharge, and daily activity after discharge to predict the long-term prognosis of patients with ACS. The multidimensional model is more effective than the single-factor model for assessing risk in ACS patients. This work also establishes a theoretical basis for improving the prognosis of potentially high-risk individuals with accurate and reasonable exercise prescriptions.

Calcified nodules in the coronary arteries: systematic review on incidence and percutaneous coronary intervention outcomes

INTRODUCTION AND OBJECTIVES

Calcified nodules (CN) have been associated with higher complexity and worse outcomes after percutaneous coronary intervention (PCI) in both stable and unstable coronary disease. The aim of this systematic review was to summarize the current evidence on CN.

METHODS

Systematic review of published studies on the prevalence, clinical associations, and impact of CN on outcomes after PCI up to November 2024.

RESULTS

We identified 474 publications, of which 87 were included (all observational). CN were divided into 2 types: noneruptive CN (NECN), with an intact fibrous cap; and eruptive CN (ECN), with disruption of the fibrous cap with or without thrombus. The most common location was the right coronary artery (28%-71%). Angiography-based diagnostic sensitivity was low (18%-38%). Optical coherence tomography was preferred for type differentiation. The main clinical factors associated with CN were older age, diabetes mellitus, and chronic kidney disease. CN were considered the culprit lesion in 3% to 18% of acute coronary syndromes but were also present in up to 30% of nonculprit arteries. ECN were associated with more events at follow-up than NECN (20% vs 3.3% at 1 year). Post-PCI, CN were associated with lower minimum lumen area (MLA), higher rates of stent-edge dissection (44%-73%), malapposition (71%-96%), and underexpansion (60%-77%). ECN were associated with better acute results but worse long-term outcomes compared with NECN.

CONCLUSIONS

CN are often present in acute coronary syndrome culprit and stable coronary lesions. Intracoronary imaging is essential for the diagnosis and differentiation of CN. CN are associated with worse outcomes after PCI, acutely and during follow-up.

Predictive Value of Pan-Immune Inflammation Value and Systemic Immune-Inflammation Index for Identifying Coronary Vulnerable Plaques: New Insights from Optical Coherence Tomography in Acute Coronary Syndrome Patients

Purpose

The predictive value of PIV and SII in identifying vulnerable plaques among ACS patients remains poorly understood. This study represents the inaugural use of OCT to identify vulnerable plaques and establishes a predictive model incorporating PIV and SII, enhancing clinical treatment strategies.

Methods

A total of 523 eligible ACS patients underwent coronary angiography and OCT. Clinical data were collected and analyzed. Multifactorial logistic regression was employed to identify factors influencing TCFA. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic accuracy of the PIV and SII for TCFA, with a calculation of the area under the ROC curve (AUC). The optimal cutoff values for PVI and SII were calculated.

Results

Compared to the non-TCFA group, the TCFA group exhibited significantly higher levels of hypersensitive C-reactive protein (hs-CRP), PIV, and SII (all P <0.05). Multifactorial logistic regression analysis revealed that PIV (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.35-2.06; P <0.001) and SII (OR, 1.52; 95% CI, 1.14-2.08; P <0.001) were independent risk factors for TCFA development. The optimal cutoff value for PIV was 490.7, achieving a diagnostic sensitivity and specificity of 75.44% and 89.32%, respectively. For SII, the optimal cutoff value was 802.9, with a diagnostic sensitivity and specificity of 67.54% and 79.61%, respectively.

Conclusion

This study suggests that PIV and SII can serve as noninvasive, practical, and cost-effective biomarkers for evaluating plaque vulnerability in patients with ACS.

Sex-related differences in coronary and carotid vessel geometry, plaque composition and shear stress obtained from imaging

Atherosclerosis manifests itself differently in men and women with respect to plaque initiation, progression and plaque composition. The observed delay in plaque progression in women is thought to be related to the hormonal status of women. Also features associated with the vulnerability of plaques to rupture seem to be less frequently present in women compared to men. Current invasive and non-invasive imaging modalities allow for visualization of plaque size, composition and high risk vulnerable plaque features. Moreover, image based modeling gives access to local shear stress and shear stress-related plaque growth. In this review, current knowledge on sex-related differences in plaque size, composition, high risk plaque features and shear stress related plaque growth in carotid and coronary arteries obtained from imaging are summarized.

Characteristics of calcified nodule attributable to culprit lesion in acute coronary syndrome: A systematic review and meta-analysis

The presence of calcified nodule (CN) is a significant characteristic of atherothrombosis in acute coronary syndrome (ACS). However, its characteristics continue to be understudied. This review aimed to further investigate these characteristics. This study found that CN was a distinctive feature of an atheromatous plaque, representing 6.3% of ACS. CN was more common in NSTE-ACS than in STEMI patients (9.4% vs. 6.6%). CN was also chiefly observed in the left anterior descendant artery (48%), followed by the right coronary (40.4%) and left circumflex (14.5%) arteries. Higher prevalence of hypertension (78.8%), diabetes mellitus (50.8%), multivessel disease (71.7%), and kidney disease (26.43%) were noted in CN compared to non-CN patients. CN-associated ACS also 6-fold increased the risk of target lesion revascularization compared to those without CN.

The research progress and research trends in acute coronary syndrome nursing: A review of visual analysis based on the Web of Science database

Acute coronary syndrome (ACS) is one of the most common and severe forms of cardiovascular disease and has attracted worldwide attention with increased morbidity and mortality in recent years. There are few review studies in the field of its care in the form of bibliometric studies. We searched the Web of Science Core Collection database for articles and reviews in the area of ACS nursing for visual mapping analysis. Our objectives are to explore the hot topics and frontiers of research in the field of ACS nursing and to identify collaborative relationships between countries, institutions, and authors. This study will provide researchers with intuitive reference data for future in-depth studies of ACSs.

Potential relationship between high wall shear stress and plaque rupture causing acute coronary syndrome

The relationship between high wall shear stress (WSS) and plaque rupture (PR) in longitudinal and circumferential locations remains uncertain. Overall, 100 acute coronary syndrome patients whose culprit lesions had PR, documented by optical coherence tomography (OCT), were enrolled. Lesion-specific three-dimensional coronary artery models were created using OCT data. WSS was computed with computational fluid dynamics analysis. PR was classified into upstream-PR, minimum lumen area-PR, and downstream-PR according to the PR's longitudinal location, and into central-PR and lateral-PR according to the disrupted fibrous cap circumferential location. In the longitudinal 3-mm segmental analysis, multivariate analysis demonstrated that higher WSS in the upstream segment was independently associated with upstream-PR, and thinner fibrous cap was independently associated with downstream-PR. In the PR cross-sections, the PR region had a significantly higher average WSS than non-PR region. In the cross-sectional analysis, the in-lesion peak WSS was frequently observed in the lateral (66.7%) and central regions (70%) in lateral-PR and central-PR, respectively. Multivariate analysis demonstrated that the presence of in-lesion peak WSS at the lateral region, thinner broken fibrous cap, and larger lumen area were independently associated with lateral-PR, while the presence of in-lesion peak WSS at the central region and thicker broken fibrous cap were independently associated with central-PR. In conclusion, OCT-based WSS simulation revealed that high WSS might be related to the longitudinal and circumferential locations of PR.

Prognostic Value of Admission Peak NT-proBNP Combined with Culprit Plaque Types for Predicting Cardiovascular Risk in ST-Segment Elevated Myocardial Infarction: An Optical Coherence Tomography Study

OBJECTIVE

Different culprit plaque phenotypes including plaque rupture (PR) and non-plaque rupture (NPR), and N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) have been reported to influence clinical outcomes in patients with acute coronary syndrome (ACS). We aimed to investigate the prognostic implication of the peak and baseline values at admission for NT-proBNP for major adverse cardiovascular events (MACE) in ST-Segment Elevated Myocardial Infarction (STEMI) patients with different plaque phenotype.

METHODS

A total of 428 patients with STEMI undergoing optical coherence tomography (OCT) were enrolled and divided into four groups: PR/Tertile1-2 NT-proBNP (n = 132), PR/Tertile3 NT-proBNP (n = 65), NPR/Tertile1-2 NT-proBNP (n = 154), NPR/Tertlie3 NT-proBNP (n = 77). Baseline and Peak values of NT-proBNP were obtained in the admission period. The MACEs were defined as the composite of all-cause death, recurrence of myocardial infarction and stroke.

RESULTS

High levels for peak NT-proBNP were significantly associated with a higher incidence of MACE and death (Log rank p = 0.037 and 0.0012, respectively). In the subgroup with NPR, a high level for peak NT-proBNP was significantly associated with higher incidence of death (Log rank p = 0.0022) but this association was not significant in the subgroup of PR (Log rank p = 0.24). Though plaque types were not associated with adverse event, the combination of NPR and a higher peak value for NT-proBNP indicated higher incidence of death compared with other groups (Log rank p = 0.0017). The area under the receiver operating characteristic curve for predicting death to evaluate the diagnostic value of the peak value for NT-proBNP and plaque types combined with traditional risk factors was 0.843 (95% CI: 0.805-0.876), which is superior to solely traditional risk factors: NRI (26.8% [95% CI: 0.4-53.1%], p = 0.046) and IDI (5.1% [95% CI: 1.0-9.2%], p = 0.016).

CONCLUSION

STEMI patients with NPR and a high level for peak NT-proBNP showed higher incidence of death. The peak value of NT-proBNP in combination with plaque types can be used in risk stratification and prediction of death in patients with STEMI.

Optical Coherence Tomography Fractional Flow Reserve and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome

BACKGROUND

Optical coherence tomography-derived fractional flow reserve (OCT-FFR) correlates strongly with wire-based FFR; however, its clinical significance remains uncertain.

OBJECTIVES

The study sought to investigate the relationship between post-percutaneous coronary intervention (PCI) OCT-FFR and long-term clinical outcomes in acute coronary syndrome (ACS).

METHODS

This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent OCT-guided emergency PCI. We analyzed post-PCI OCT images and calculated OCT-FFR to identify independent factors associated with target vessel failure (TVF) after PCI.

RESULTS

Among 364 enrolled patients, 54 experienced TVF during a median follow-up of 36 (IQR: 26-48) months. Vessel-level OCT-FFR was significantly lower in the TVF group than in the non-TVF group (0.87 vs 0.94; P < 0.001). In the multivariable Cox regression analysis, low vessel-level OCT-FFR (HR per 0.1 increase: 0.38; 95% CI: 0.29-0.49; P < 0.001) and thin-cap fibroatheroma in the nonculprit lesion were independently associated with TVF. The TVF rate of vessels with both low vessel-level OCT-FFR (<0.90) and thin-cap fibroatheroma in the nonculprit lesion was 8.1 times higher than that of all other vessels (69.3% vs 12.4%; HR: 8.13; 95% CI: 4.33-15.25; log-rank P < 0.001). Furthermore, adding vessel-level OCT-FFR to baseline characteristics and post-PCI OCT findings improved discriminatory and reclassification ability in identifying patients with subsequent TVF.

CONCLUSIONS

Vessel-level OCT-FFR was an independent factor associated with TVF after PCI in patients with ACS. Adding the OCT-FFR measurement to post-PCI OCT findings may enable better discrimination of patients with subsequent TVF after PCI for ACS. (Relationship between Intracoronary Optical Coherence Tomography Derived Virtual Fractional Flow Reserve and cardiovascular outcome on Acute coronary syndrome; UMIN000043858).

Rationale and design of the TACTICS registry: Optical coherence tomography guided primary percutaneous coronary intervention for patients with acute coronary syndrome

BACKGROUND

Recent retrospective investigations have suggested that optical coherence tomography (OCT) enables the diagnosis of underlying acute coronary syndrome (ACS) causes such as plaque rupture, plaque erosion, and calcified nodule. The relationships of these etiologies with clinical outcomes, and the clinical utility of OCT-guided primary percutaneous coronary intervention (PCI) are not systematically studied in real-world ACS treatment settings.

METHODS

The TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 21 hospitals in Japan. A total of 700 patients with ACS (symptom onset within 24 h) undergoing OCT-guided primary PCI will be enrolled. The primary endpoint of the study is to identify the underlying causes of ACS using OCT-defined morphological assessment of the culprit lesion. The key secondary clinical endpoints are hazard ratios of the composite of cardiovascular death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization in patients with underlying etiologies at the 12- and 24-month follow-ups. The feasibility of OCT-guided primary PCI for ACS will be assessed by the achievement rates of optimal post-procedural results and safety endpoints.

CONCLUSION

The TACTICS registry will provide an overview of the underlying causes of ACS using OCT, and will reveal any difference in clinical outcomes depending on the underlying causes. The registry will also inform on the feasibility of OCT-guided primary PCI for patients with ACS.

Advantages and prospects of optical coherence tomography in interventional therapy of coronary heart disease (Review)

Coronary heart disease is the leading cause of mortality among all diseases globally. Percutaneous coronary intervention (PCI) is a key method for the treatment of coronary heart disease. Optical coherence tomography (OCT) is an optical diagnostic technology with a resolution of up to 10 µm, which is able to accurately assess the composition of the coronary arterial wall and determine the characteristics of atherosclerotic lesions. It is also highly consistent with pathological examinations, optimizing the effect of stent implantation and evaluation of the long-term effectiveness and safety of the stent, which has irreplaceable value in the field of precision and optimization of coronary intervention. The innovative OCT technology may help provide more comprehensive clinical research evidence. The application of OCT in clinical and basic research of coronary atherosclerosis, selection of treatment strategies for acute coronary syndromes, optimization of interventional treatment efficacy, evaluation of novel stents, intimal stent coverage and selection of dual antiplatelet drugs has become more widely used, affecting the current coronary interventional treatment strategies to a certain extent. The aim of the present review was to discuss the role of OCT in evaluating preoperative plaque characteristics, guiding PCI and evaluating the effects of postoperative stents or drug treatments.

Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study population were 150 consecutive patients treated for acute myocardial infarction. Results: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p=0,07), number of diseased vessels (p=0,027), and need for loop diuretic therapy (p=0,050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors. Keywords: myocardial infarction, cardiac biomarkers, cardiac troponin, natriuretic peptide, prognosis, major adverse cardiac events (MACE), cardiac death