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?

Summary

In 1,312 AMI patients with 3-vessel OCT imaging and 4.1-year median follow-up, non-culprit TCFA—rather than angiographic stenosis—independently predicted recurrent MACEs at both patient and lesion levels. Event rates rose with increasing numbers of obstructive lesions or TCFAs.

Key Findings

• In 1,312 AMI patients, OCT-defined TCFA independently predicted recurrent MACEs; angiographic stenosis did not when modeled together.
• Obstructive non-culprit lesions had higher TCFA prevalence; lesion-level HR for TCFA was 2.39 (95% CI 1.29–4.43).
• Event rates increased with the number of obstructive stenoses or TCFAs in non-culprit segments.

Clinical Implications

Consider integrating plaque morphology (OCT) into risk assessment post-MI to guide intensification of preventive therapies and surveillance, beyond angiographic stenosis evaluation.

Limitations

• Observational design; no randomized intervention based on TCFA findings
• Potential selection bias and center-specific imaging practice variability

Future Directions

Randomized trials testing morphology-guided therapy intensification and non-culprit interventions; integration with noninvasive plaque imaging and inflammatory biomarkers.