Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Oct 2023)

Diagnosis and Prognostic Value of the Underlying Cause of Acute Coronary Syndrome in Optical Coherence Tomography–Guided Emergency Percutaneous Coronary Intervention

  • Seita Kondo,
  • Takuya Mizukami,
  • Nobuaki Kobayashi,
  • Kohei Wakabayashi,
  • Hiroyoshi Mori,
  • Myong Hwa Yamamoto,
  • Takehiko Sambe,
  • Sakiko Yasuhara,
  • Kiyoshi Hibi,
  • Mamoru Nanasato,
  • Tomoyo Sugiyama,
  • Tsunekazu Kakuta,
  • Takeshi Kondo,
  • Satoru Mitomo,
  • Sunao Nakamura,
  • Masamichi Takano,
  • Taishi Yonetsu,
  • Takashi Ashikaga,
  • Tomotaka Dohi,
  • Hirosada Yamamoto,
  • Ken Kozuma,
  • Jun Yamashita,
  • Junichi Yamaguchi,
  • Hiroshi Ohira,
  • Kaneto Mitsumata,
  • Atsuo Namiki,
  • Shigeki Kimura,
  • Junko Honye,
  • Nozomi Kotoku,
  • Takumi Higuma,
  • Makoto Natsumeda,
  • Yuji Ikari,
  • Teruo Sekimoto,
  • Hidenari Matsumoto,
  • Hiroshi Suzuki,
  • Hiromasa Otake,
  • Yoichiro Sugizaki,
  • Naoei Isomura,
  • Masahiko Ochiai,
  • Satoru Suwa,
  • Toshiro Shinke

DOI
https://doi.org/10.1161/JAHA.123.030412
Journal volume & issue
Vol. 12, no. 20

Abstract

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Background The prognostic impact of optical coherence tomography–diagnosed culprit lesion morphology in acute coronary syndrome (ACS) has not been systematically examined in real‐world settings. Methods and Results This investigator‐initiated, prospective, multicenter, observational study was conducted at 22 Japanese hospitals to identify the prevalence of underlying ACS causes (plaque rupture [PR], plaque erosion [PE], and calcified nodules [CN]) and their impact on clinical outcomes. Patients with ACS diagnosed within 24 hours of symptom onset undergoing emergency percutaneous coronary intervention were enrolled. Optical coherence tomography–guided percutaneous coronary intervention recipients were assessed for underlying ACS causes and followed up for major adverse cardiac events (cardiovascular death, myocardial infarction, heart failure, or ischemia‐driven revascularization) at 1 year. Of 1702 patients with ACS, 702 (40.7%) underwent optical coherence tomography–guided percutaneous coronary intervention for analysis. PR, PE, and CN prevalence was 59.1%, 25.6%, and 4.0%, respectively. One‐year major adverse cardiac events occurred most frequently in patients with CN (32.1%), followed by PR (12.4%) and PE (6.2%) (log‐rank P<0.0001), primarily driven by increased cardiovascular death (CN, 25.0%; PR, 0.7%; PE, 1.1%; log‐rank P<0.0001) and heart failure trend (CN, 7.1%; PR, 6.8%; PE, 2.2%; log‐rank P<0.075). On multivariate Cox regression analysis, the underlying ACS cause was associated with 1‐year major adverse cardiac events (CN [hazard ratio (HR), 4.49 [95% CI, 1.35–14.89], P=0.014]; PR (HR, 2.18 [95% CI, 1.05–4.53], P=0.036]; PE as reference). Conclusions Despite being the least common, CN was a clinically significant underlying ACS cause, associated with the highest future major adverse cardiac events risk, followed by PR and PE. Future studies should evaluate the possibility of ACS underlying cause‐based optical coherence tomography–guided optimization.

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