Journal of cardiology · 2026
Clinical outcomes and optical coherence tomography findings in myocardial infarction patients without standard modifiable risk factors: Insights from the TACTICS registry.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Wada Hideki, Dohi Tomotaka, Ogita Manabu, Suwa Satoru, Kobayashi Nobuaki, Takano Masamichi, Kondo Seita, Sugiyama Tomoyo, Kakuta Tsunekazu, Wakabayashi Kohei, Mori Hiroyoshi, Kimura Shigeki, Mitomo Satoru, Nakamura Sunao, Higuma Takumi, Yamaguchi Junichi, Yonetsu Taishi, Natsumeda Makoto, Ikari Yuji, Yamashita Jun, Mizukami Takuya, Yamamoto Myong Hwa, Shinke Toshiro
Аннотация
BACKGROUND: Patients with coronary artery disease who lack any standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) have attracted much attention in recent years due to their unexpectedly poor clinical outcomes. This study aimed to perform optical coherence tomography (OCT)-based evaluation of the characteristics and morphology of coronary culprit lesions of patients with acute myocardial infarction (AMI) but without any SMuRFs, in a prospective multicenter registry.
METHODS: Patients with AMI diagnosed within 24 h of symptom onset who underwent OCT-guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to characterize the coronary artery lesions of patients without any SMuRFs.
RESULTS: A total of 640 AMI patients were enrolled. Of these, 58 (9%) had no SMuRFs and were in poor clinical condition at presentation, including acute heart failure or cardiogenic shock. OCT found no difference in the morphology of the culprit lesions in terms of presence or absence of SMuRFs. Rates of lipid plaque lesions and plaque calcification >180 degrees were lower in patients without SMuRFs. The risk of cardiovascular events at 12 months was higher in patients without SMuRFs than with SMuRFs (adjusted hazard ratio 2.28, 95% confidence interval 1.13-4.23, p = 0.02).
CONCLUSIONS: OCT evaluation revealed less lipid plaque and severe calcification in patients without SMuRFs than in those with SMuRFs. This finding indicates that the poor prognosis in the patient group without SMuRFs is due to the poor state of these patients at the time of onset rather than to the morphology of coronary artery lesions.
METHODS: Patients with AMI diagnosed within 24 h of symptom onset who underwent OCT-guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to characterize the coronary artery lesions of patients without any SMuRFs.
RESULTS: A total of 640 AMI patients were enrolled. Of these, 58 (9%) had no SMuRFs and were in poor clinical condition at presentation, including acute heart failure or cardiogenic shock. OCT found no difference in the morphology of the culprit lesions in terms of presence or absence of SMuRFs. Rates of lipid plaque lesions and plaque calcification >180 degrees were lower in patients without SMuRFs. The risk of cardiovascular events at 12 months was higher in patients without SMuRFs than with SMuRFs (adjusted hazard ratio 2.28, 95% confidence interval 1.13-4.23, p = 0.02).
CONCLUSIONS: OCT evaluation revealed less lipid plaque and severe calcification in patients without SMuRFs than in those with SMuRFs. This finding indicates that the poor prognosis in the patient group without SMuRFs is due to the poor state of these patients at the time of onset rather than to the morphology of coronary artery lesions.