Impact of Carrying DNMT3A or TET2 Mutations on Plaque Characteristics and Prognosis in Patients With STEMI Based on OCT

作者：Qianhui Sun, Shengfang Wang, Ming Zeng, Minghao Liu, Chen Zhao, Boling Yi, Sining Hu, Bo Yu, Haibo Jia · 发表于：Circulation Cardiovascular Imaging · 年份：2025 · DOI：10.1161/circimaging.124.017915 · 被引用次数：5 · 研究领域：Coronary Interventions and Diagnostics、Peripheral Artery Disease Management、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Clonal hematopoiesis of indeterminate potential is a novel, nontraditional risk factor linked to coronary heart disease. DNMT3A and TET2 are the 2 most prevalent clonal hematopoiesis of indeterminate potential-associated driver genes. This study aims to evaluate their effects on plaque characteristics and prognosis in patients with ST-segment–elevation myocardial infarction. METHODS: Consecutive patients with ST-segment–elevation myocardial infarction (May 2017–May 2019) undergoing routine optical coherence tomography were enrolled. Targeted deep exome sequencing of peripheral blood (custom panel targeting DNMT3A and TET2 ) identified mutations (with a threshold variant allele frequency ≥2%). The primary end point was major adverse cardiovascular events, defined as a composite end point that includes all-cause death, nonfatal myocardial infarction, nonfatal stroke, and revascularization due to clinical ischemic events. RESULTS: Among 628 patients, 12.3% were identified as carriers of DNMT3A or TET2 gene mutations. Patients with DNMT3A/TET2 mutations were older (62.5 versus 55.6 years; P <0.001), while the 2 groups showed comparable prevalence rates of hypertension (48.1% versus 43.2%), diabetes (22.1% versus 22.3%), and dyslipidemia (53.2% versus 61.7%). Carriers demonstrated greater plaque vulnerability characteristics on optical coherence tomography, including a higher macrophage proportion, smaller minimal lumen area, thinner fibrous cap, and higher lipid in...