The following is a summary of “Diagnosis and Prognostic Value of the Underlying Cause of Acute Coronary Syndrome in Optical Coherence Tomography–Guided Emergency Percutaneous Coronary Intervention,” published in the October 2023 issue of Cardiology by Kondo et al.

This research aims to evaluate the predictive value of culprit lesion morphology, identified through optical coherence tomography (OCT), in acute coronary syndrome (ACS) within a real-world clinical setting.

This prospective, multicenter observational study involved 22 Japanese hospitals. The study focused on identifying the prevalence of various underlying ACS causes—plaque rupture (PR), plaque erosion (PE), and calcified nodules (CN)—and their effects on patient outcomes. It enrolled individuals experiencing ACS within 24 hours of symptom onset who underwent emergency percutaneous coronary intervention (PCI) guided by OCT. Among 1,702 ACS patients, 702 (40.7%) underwent OCT-guided PCI and were analyzed. PR, PE, and CN prevalence was 59.1%, 25.6%, and 4.0%, respectively. Over a year-long follow-up, major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization, were most frequent among patients with CN (32.1%), followed by PR (12.4%) and PE (6.2%) (log-rank P<0.0001). These events were primarily driven by elevated rates of cardiovascular death in the CN group (25.0%). Multivariate Cox regression analysis revealed that the underlying ACS cause was independently associated with one-year MACE risk (CN [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. 

Although less common, CN was identified as a significant underlying cause of ACS, associated with the highest risk of future major adverse cardiac events, followed by PR and PE. The findings emphasize the potential value of OCT-guided optimization based on the cause of ACS, warranting further investigation.

Source: ahajournals.org/doi/10.1161/JAHA.123.030412