Observational studyThe international journal of cardiovascular imaging2026
Relationship between culprit lesion high-risk plaque features and adverse cardiovascular outcome at two years follow-up in patients with acute coronary syndrome. Insights from the OPTICO-ACS study.
Observational study in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High-risk plaque features detected by optical coherence tomography (OCT) in culprit lesions (CL) of acute coronary syndrome (ACS) are linked to adverse cardiovascular outcomes. Whether the coexistence of multiple high-risk features within the same CL confers additional prognostic impact remains unknown. Within the multicentric, translational OPTICO-ACS study, the CL of 338 ACS-patients undergoing pre-intervention OCT-imaging were screened for the presence of conventional high-risk plaque features. The primary endpoint was the incidence of major adverse cardiac events plus (MACE +) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization and re-hospitalization for progressive or unstable angina pectoris at two years follow-up. The relationship between each individual and multiple co-occurring high-risk features were comprehensively compared between patients with – and without clinical events. A ruptured fibrous cap [80% vs 51.2%; HR = 1.816 (1.050–3.142); p = 0.033], cholesterol crystals [71.3% vs 53.5%; HR = 1.936 (1.193–3.142); p = 0.008] and a high maximum lipid arc [78.8% vs. 48.2%; HR = 1.947 (1.140–3.328); p = 0.015)] each occurred more frequently in patients with clinical events as compared to patients without clinical events. The co-existence of all three high-risk plaque features (Triple Positive Plaque – TPP) within the same CL showed the strongest association with the primary endpoint (HR = 2.282 (1.462–3.562; p < 0.001). Adding TPP to baseline clinical risk, showed the strongest improvement in prediction accuracy for MACE + , as represented by an improvement in C-statistics of 0.056; p < 0.001. TPP showed the strongest association with the primary endpoint and significantly improved prediction accuracy for MACE + . This finding may support risk stratification after ACS and may justify enhanced secondary preventive measures.
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