Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction

Kang-Ling Wang, Craig Balmforth, Mohammed N. Meah, Marwa Daghem, Alastair J. Moss, Evangelos Tzolos, Jacek Kwiecinski, Patrycja Molek-Dziadosz, Neil Craig, Anda Bularga, Philip D. Adamson, Dana K. Dawson, Parthiban Arumugam, Nikant K. Sabharwal, John P. Greenwood, Jonathan N. Townend, Patrick A. Calvert, James H.F. Rudd, Johan W. Verjans, Daniel S. BermanPiotr J. Slomka, Damini Dey, Nicholas L. Mills, Edwin J.R. van Beek, Michelle C. Williams, Marc R. Dweck, David E. Newby

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Total coronary atherosclerotic plaque activity across the entire coronary arterial tree is associated with patient-level clinical outcomes. Objectives: We aimed to investigate whether vessel-level coronary atherosclerotic plaque activity is associated with vessel-level myocardial infarction. Methods: In this secondary analysis of an international multicenter study of patients with recent myocardial infarction and multivessel coronary artery disease, we assessed vessel-level coronary atherosclerotic plaque activity using coronary 18F-sodium fluoride positron emission tomography to identify vessel-level myocardial infarction. Results: Increased 18F-sodium fluoride uptake was found in 679 of 2,094 coronary arteries and 414 of 691 patients. Myocardial infarction occurred in 24 (4%) vessels with increased coronary atherosclerotic plaque activity and in 25 (2%) vessels without increased coronary atherosclerotic plaque activity (HR: 2.08; 95% CI: 1.16-3.72; P = 0.013). This association was not demonstrable in those treated with coronary revascularization (HR: 1.02; 95% CI: 0.47-2.25) but was notable in untreated vessels (HR: 3.86; 95% CI: 1.63-9.10; P interaction = 0.024). Increased coronary atherosclerotic plaque activity in multiple coronary arteries was associated with heightened patient-level risk of cardiac death or myocardial infarction (HR: 2.43; 95% CI: 1.37-4.30; P = 0.002) as well as first (HR: 2.19; 95% CI: 1.18-4.06; P = 0.013) and total (HR: 2.50; 95% CI: 1.42-4.39; P = 0.002) myocardial infarctions. Conclusions: In patients with recent myocardial infarction and multivessel coronary artery disease, coronary atherosclerotic plaque activity prognosticates individual coronary arteries and patients at risk for myocardial infarction.

Original languageEnglish
Pages (from-to)2135-2144
JournalJournal of the American College of Cardiology
Volume83
Issue number22
DOIs
Publication statusPublished - 4 Jun 2024

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