Plaque characteristics derived from intravascular optical coherence tomography that predict major adverse cardiovascular events

Background With its near histological resolution and its optical contrast, intravascular optical coherence tomography (IVOCT) is the only imaging modality that allows a unique assessment of microscopic plaque characteristics. This study aimed to investigate whether plaque characteristics derived from IVOCT could predict a long-term major adverse cardiovascular event (MACE). Methods This study was a single-center, retrospective study on 104 patients who had undergone IVOCT-guided percutaneous coronary intervention. Plaque characterization was performed using OCTOPUS software developed by our group. A total of 31 plaque features, including lesion length, lumen, calcium, fibrous cap (FC), and vulnerable plaque features (e.g., microchannel and cholesterol crystal), were computed from the baseline IVOCT images (obtained before stenting). For IVOCT plaque features, the discriminatory power for predicting MACE was determined using univariate/multivariate logistic regression as assessed by area under the receiver operating characteristic curve (AUC). Results Of 104 patients, MACE was identified in 24 patients (23.1%). Univariate logistic regression revealed that lesion length, maximum calcium angle, maximum calcium thickness, maximum FC angle, maximum FC area, and FC surface area were significantly associated with MACE (p<0.05). Additionally, cholesterol crystal and layered plaque showed a strong association with MACE (p<0.05). In the multivariate logistic analysis, only the FC surface area (OR 2.38, CI 0.98-5.83, p<0.05) was identified as a significant determinant for MACE, highlighting the importance of the 3D lesion analysis. The AUC of FC surface area for predicting MACE was 0.851 (95% CI 0.800-0.927, p<0.05). Luminal stenosis was not a strong predictor of the risk of MACE. Conclusions Patients with MACE had distinct plaque characteristics in IVOCT. In particular, large FC surface areas were a risk factor. Interestingly, cap thickness, a commonly highlighted feature for lesion vulnerability, was less predictive than cap area. Studies such as this one might someday lead to recommendations for pharmaceutical and interventional approaches. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N/A ### Funding Statement This project was supported by the National Heart, Lung, and Blood Institute through grants NIH R21HL108263, NIH R01HL114406, and NIH R01HL143484. This research was conducted in space renovated using funds from an NIH construction grant (C06 RR12463) awarded to Case Western Reserve University. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted in compliance with the Declaration of Helsinki and received approval from the Institutional Review Board of University Hospitals Cleveland Medical Center (Cleveland, Ohio, USA). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The datasets generated and/or analyzed during the current study are not publicly available due to legal/ethical reasons but are available from the corresponding author on reasonable request.