Long-term Prognostic Impact of Optical Coherence Tomography Detected Plaque Rupture in Nonculprit Coronary Segments.

BACKGROUND AND AIMS:Atherosclerotic plaque rupture is largely acknowledged as the main mechanism of acute coronary syndrome. However, the prognostic significance of plaque rupture detected in nonculprit coronary sites remains largely unknown. METHODS:We investigated the long-term clinical outcomes of nonculprit plaque rupture detected by optical coherence tomography in the prospective CLIMA study. The primary composite endpoint was cardiac death or target-segment myocardial infarction (TS-MI) through 5-year follow-up. RESULTS:Among 1003 patients (age 64.8y; 24.6% women), nonculprit plaque rupture was observed in 7.3% of patients. Three-vessel disease, total plaque length, thin-cap fibroatheroma and large lipid arc were independently associated with nonculprit plaque rupture. The presence of nonculprit plaque rupture was associated with the primary endpoint at univariable (HR 2.09, 95%CI 1.07-4.08, p = 0.030) but not clinical (adjusted HR 1.70, 95%CI 0.83-3.48, p = 0.145) and morphological (adjusted HR 1.63, 95%CI 0.83-3.21, p = 0.156) multivariable analysis. The individual rates of cardiac death (HR 1.64, 95%CI 0.70-3.85, p = 0.252) and TS-MI (HR 2.87, 95%CI 0.97-8.47, p = 0.057) did not significantly differ between patients with vs without nonculprit plaque rupture. At the Kaplan-meier analysis, the presence of nonculprit plaque rupture was significantly associated with the primary endpoint only in presence of a thin-cap fibroatheroma (TCFA). The presence of nonculprit plaque rupture did not improve the predictive accuracy of any TCFA in multiple prediction models. CONCLUSIONS:Nonculprit plaque rupture was associated with cardiac events at univariable but not multivariable analysis. Identification of nonculprit PR did not improve the predictive value of established high-risk morphological features such as TCFA; however, future ad hoc studies are needed to further clarify its potential independent clinical relevance. CLINICAL TRIAL REGISTRATION:URL: https://www. CLINICALTRIALS:gov; Unique identifier: NCT02883088.