Long-Term Prognostic Implications of Non-Culprit Lesions in Patients Presenting With an Acute Myocardial Infarction: Is It the Angiographic Stenosis Severity or the Underlying High-Risk Morphology?

作者：Jihong Dai, Jiawei Zhao, Xueming Xu, Yuzhu Chen, Sibo Sun, Shuang Li, Lina Cui, Yini Wang, Lulu Li, Rong Guo, Dongxu Huang, Xianqin Ma, Rui Zhao, Huai Yu, Tao Chen, Jinfeng Tan, Xiaohui Liu, Senqing Jiang, Jingbo Hou, Chao Fang, Gary S. Mintz, Bo Yu · 发表于：Circulation · 年份：2025 · DOI：10.1161/circulationaha.124.071855 · 被引用次数：10 · 研究领域：Coronary Interventions and Diagnostics、Cardiac tumors and thrombi、Cardiac Imaging and Diagnostics

BACKGROUND: Patients with acute myocardial infarction and angiographically obstructive non-culprit lesions are at high risk for recurrent major adverse cardiac events (MACEs). However, it remains largely unknown whether events are due to stenosis severity or due to the underlying high-risk lesion morphology. METHODS: Between January 2017 and December 2021, 1312 patients with acute myocardial infarction underwent optical coherence tomography of all the 3 main epicardial arteries after successful percutaneous coronary intervention. Patients and lesions were categorized according to the presence or absence of (1) 1 or more non-culprit angiographic obstructive stenoses with a visual diameter stenosis of ≥50% and (2) 1 or more lesions with an underlying high-risk morphology defined as an optical coherence tomography thin-cap fibroatheroma (TCFA). Patients were followed for up to 5 years (median 4.1 [interquartile range: 3.0-5.0] years). MACEs comprised cardiac death, non-fatal myocardial infarction, and unplanned coronary revascularization. RESULTS: Overall, 492 patients had at least 1 obstructive non-culprit lesion, 352 had a single lesion, and 140 had multiple obstructive non-culprit lesions. The presence and number of angiographic obstructive non-culprit lesions correlated with the proportion and number of optical coherence tomography-derived TCFAs. At the lesion level, the prevalence of TCFA was twice as high in obstructive lesions compared with nonobstructive lesions. Patient...