Table 2.
Studies providing the invasive and non-invasive assessment of NCLs in patients with multivessel coronary disease.
| Study, years | Sample size | NCLs severity | Primary outcome | Main result |
|---|---|---|---|---|
| Coronary physiology | ||||
| FLOWER-MI, 2021 | 1171 | Angiographic diameter stenosis >50% vs Angiography diameter stenosis >50% and FFR<0.80 | MACE: Death, non-fatal MI, unplanned hospitalization leading to urgent revascularization at 12 months FU | Complete multivessel PCI guided by FFR did not show significant benefit compared to PCI guided by angiography alone |
| FRAME-AMI, 2022 | 562 | Angiographic diameter stenosis >50% vs Angiography diameter stenosis >50% and FFR<0.80 | MACE: Death, MI and repeat revascularization, at 41 months FU. | Complete multivessel PCI guided by FFR reduced the risk of MACE compared to PCI guided by angiography alone |
| Intravascular imaging | ||||
| PROSPECT, 2011 | 697 | Three-vessel IVUS for the assessment of plaque features | MACE: CV death, cardiac arrest, MI, rehospitalization due to unstable or progressive angina at 36 months FU. | The presence of plaque burden ≥70%, TCFA and an MLA ≤4mm2 were independent predictors of MACE |
| ATHEROREMO-NIRS, 2014 | 203 | NIRS for the assessment of lipid-rich plaques | MACE: Death, non-fatal MI, stroke, unplanned coronary revascularization at 12 months FU | The presence of lipid-rich plaques was associated with higher risk of MACE |
| CLIMA, 2020 | 1003 | OCT for the assessment of plaque features | MACE: cardiac death and target segment myocardial infarction at 12 months FU | MLA<3.5 mm2, fibrous cap thickness <75 μm, lipid arc circumferential extension>180, and macrophage infiltration were associated with a higher risk of MACE |
| COMBINE OCT-FFR, 2021 | 550 | OCT detected TCFA in diabetes patients with negative FFR value | MACE: CV death, target vessel MI, clinically driven target lesion revascularization or hospitalization due to unstable or progressive angina at 18 months | The presence of TCFA was associated with higher risk of MACE |
| Non-invasive diagnostic tools | ||||
| PROMISE, 2018 | 4415 | CCTA for the assessment of high-risk plaque features | MACE: death, myocardial infarction, or unstable angina at 25 months | Positive remodelling, low computed tomographic attenuation, or napkin-ring sign were associated with a higher risk of MACE |
| REDUCE-MVI sub-study, 2020 | 77 | Stress perfusion CMR with adenosine Vs FFR<0.80 | The agreement between CMR and invasive FFR in the assessment of NCLs at 1 month | The diagnostic performance of CMR was moderate when compared to invasive FFR assessment |
CCTA, coronary computed tomography angiography; CMR, cardiac magnetic resonance; CV, cardiovascular; FFR, fractional flow reserve; FU, follow-up; IVUS, intravascular ultrasound; MI, myocardial infarction; MACE, major adverse cardiac events; MLA, minimal lumen area; MVD, multivessel disease; NCLs, non-culprit lesions; OCT, Optical coherence tomography; PCI, percutaneous coronary intervention; TFCA, tin-cap fibroatheroma.