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Complete revascularisation for obstructive non-culprit lesions with vulnerable plaque

Presented by
Dr Natalia Pinilla-Echeverri, McMaster University, Canada
AHA 2019
Dr Natalia Pinilla-Echeverri (McMaster University, Canada) presented new results from a sub-study of the COMPLETE trial analysing the optical coherence tomography (OCT) data from participants. This data determined that 47% of the patients in that trial had obstructive non-culprit lesions with vulnerable plaque, which may contribute to the improved outcomes observed with complete versus culprit lesion-only revascularisation in the main trial [1].

The results of the COMPLETE trial published in September 2019 showed that patients with ST segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease who underwent complete revascularisation benefitted from a lower risk for cardiovascular (CV) death or new myocardial infarction (MI) [2]. However, as Dr Pinilla-Echeverri explained during her presentation, “whether the benefit of routine non-culprit lesion percutaneous coronary intervention might be associated with vulnerable plaque morphology is unclear.”

Using OCT to image thin-cap fibroatheromas, the researchers identified vulnerable plaques in 93 patients (mean age 61 years; 83% male). Among obstructive lesions, 35.4% were identified as containing thin-cap fibroatheroma, while only 23.2% of non-obstructive lesions had thin-cap fibroatheroma (P=0.022). Although the lengths and lumen areas of obstructive versus non-obstructive thin-cap fibroatheromas were similar, significant differences were observed in the lesion lipid content and features of plaque vulnerability.

Overall, nearly half (47.3%) of patients undergoing OCT in this analysis had an obstructive non-culprit lesion with vulnerable plaque. The researchers concluded that these findings may help explain the benefit of routine percutaneous coronary intervention of obstructive non-culprit lesions in patients with STEMI and multivessel disease. Further research is required to determine the best strategy post-PCI for the STEMI patients with only non-culprit obstructive lesions and without vulnerable plaque morphology as determined by OCT.

  1. Pinilla-Echeverri N, et al. OCT COMPLETE: Non-culprit Lesion Plaque Morphology in Patients with ST-segment Elevation Myocardial Infarction: Substudy from the Complete Trial using Optical Coherence Tomography (OCT). LBS04, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.
  2. Mehta SR, et al. Complete Revascularization with Multivessel PCI for Myocardial Infarction. N Engl J Med. 2019 Oct 10;381(15):1411-1421.


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