Study on the association between neovascularization of culprit lesions and plaque rupture in patients with acute myocardial infarction.

Background: Neovascularization (NV) within plaques is widely recognized as an important indicator of plaque vulnerability; however, the relationship between NV and plaque rupture in patients with acute myocardial infarction (AMI) has not been extensively evaluated. The purpose of this study was to investigate the association between NV of culprit lesions and plaque rupture in patients with AMI.

Methods: This study included 384 patients diagnosed with AMI. All patients were divided into Non-NV and NV groups according to whether NV was present in the optical coherence tomography (OCT) images of the preoperative culprit lesions.

Results: Patients with NV lesions had thinner minimal fibrous cap thickness, smaller minimal lumen area and symmetry, longer lesion length, and larger plaque volume and plaque burden than patients with AMI without NV lesions ( < 0.05). Patients with both AMI and NV had a higher incidence of thin-cap fibroatheroma, cholesterol crystals, macrophages, thrombus, calcific plaque, lipid-rich plaque, and plaque rupture ( < 0.01). After adjusting for covariates, NV is independently associated with plaque rupture (OR 3.21, 95% CI 2.00-5.14; < 0.001). For the evaluation of the model after adjusting the covariates, the receiver operating characteristic (ROC) curve, clinical calibration curve, and decision curve analysis (DCA) of the model show good discriminative ability, prediction accuracy, and clinical utility.

Conclusions: In patients with AMI, NV of culprit lesions is significantly correlated with plaque growth, formation of unstable plaque phenotypes, and plaque rupture. NV may be an effective predictor of plaque rupture in AMI patients.