Identification of anatomic risk factors for acute coronary events by optical coherence tomography in patients with myocardial infarction and residual nonflow limiting lesions: rationale and design of the PECTUS-obs study

Jan-Quinten Mol, Anouar Belkacemi, Rick H. J. A. Volleberg, Martijn Meuwissen, Alexey Protopopov, Peep Laanmets, Oleg Krestyaninov, Robert Dennert, Rohit M. Oemrawsingh, Jan-Peter van Kuijk, Karin Arkenbout, Dirk J. van der Heijden, Saman Rasoul, Erik Lipsic, Steven Teerenstra, Cyril Camaro, Peter Damman, Maarten A. H. van Leeuwen, Robert-Jan van Geuns, Niels van Royen*

*Corresponding author for this work

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    Abstract

    Introduction In patients with myocardial infarction, the decision to treat a nonculprit lesion is generally based on its physiological significance. However, deferral of revascularisation based on nonischaemic fractional flow reserve (FFR) values in these patients results in less favourable outcomes compared with patients with stable coronary artery disease, potentially caused by vulnerable nonculprit lesions. Intravascular optical coherence tomography (OCT) imaging allows for in vivo morphological assessment of plague 'vulnerability' and might aid in the detection of FFR-negative lesions at high risk for recurrent events.

    Methods and analysis The PECTUS-obs study is an international rnulticentre prospective observational study that aims to relate OCT-derived vulnerable plaque characteristics of nonflow limiting, nonculprit lesions to clinical outcome in patients with myocardial infarction. A total of 438 patients presenting with myocardial infarction (ST-elevation myocardial infarction and non-ST-elevation myocardial infarction) will undergo OCT-imaging of any FFR-negative nonculprit lesion for detection of plaque vulnerability. The primary study endpoint is a composite of major adverse cardiovascular events (all-cause mortality, nonfatal myocardial infarction or unplanned revascularisation) at 2-year follow-up. Secondary endpoints will be the same composite at 1-year and 5-year follow-up, target vessel failure, target vessel revascularisation, target lesion failure and target lesion revascularisation.

    Ethics and dissemination This study has been approved by the Medical Ethics Committee of the region Amhem-Nijmegen. The results of this study will be disseminated in a main paper and additional papers with subgroup analyses.

    Original languageEnglish
    Article number048994
    Number of pages7
    JournalBMJ Open
    Volume11
    Issue number7
    DOIs
    Publication statusPublished - 2021

    Keywords

    • FRACTIONAL FLOW RESERVE
    • ARTERY-DISEASE
    • INTRAVASCULAR ULTRASOUND
    • ANGIOGRAPHY
    • PLAQUES
    • INTERVENTION
    • ANGIOPLASTY
    • ACQUISITION
    • MANAGEMENT
    • FEATURES

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