Silent plaque ruptures in non-obstructive lesions of non–infarct-related arteries: a multimodality, serial intracoronary imaging study
European Heart Journal, 2026
Kakizaki R., Biccirè F., Losdat S., Ueki Y., Häner J., Shibutani H., Otsuka T., Bär S., Lønborg J., Spitzer E., Siontis G., Ondracek A., van Geuns R., Wang Y., Matter C., Iglesias J., Spirk D., Daemen J., Fahrni G., Mahfoud F., Engstrøm T., Lang I., Koskinas K., Räber L.
| Disease area | Application area | Sample type | Products |
|---|---|---|---|
CVD | Pathophysiology | Plasma |  Olink Target 96 |
Abstract
Background and Aims
Plaque rupture can occur at non-obstructive lesions in non–infarct-related coronary arteries (non-IRAs) without inducing ischaemia. This study aimed to: (1) assess the frequency and lesion characteristics of plaque rupture in non-IRAs of acute myocardial infarction (AMI) patients, (2) evaluate morphological changes in rupture sites over 52 weeks, and (3) investigate the baseline morphology of new-onset ruptures.
Methods
This study analysed pooled data from the IBIS-4 and PACMAN-AMI trials. Patients presenting with AMI underwent multimodality intracoronary imaging of non-IRAs at baseline and after 52 weeks.
Results
Among 783 lesions from 336 patients evaluated at baseline, plaque rupture was observed in 41 lesions of 40 patients (12%). Biomarkers including lipid and inflammation markers were comparable between patients with and without rupture in non-IRAs. Lesions with rupture showed larger percent atheroma volume (53.3 ± 6.4 vs. 49.5 ± 5.8%, estimated difference 3.6[1.9 to 5.4]), larger external elastic membrane area (20.5 ± 4.8 vs. 15.7 ± 5.6 mm2, 4.1[2.5 to 5.7]), and smaller minimum fibrous cap thickness (69 ± 49 vs. 116 ± 84 μm, −43[−75 to −11]) compared to those without. Among 41 rupture sites assessed serially, 21 (51%) healed by 52 weeks. At follow-up, 10 rupture sites were newly identified, and thin-cap fibroatheroma was the most frequent baseline morphology of those.
Conclusions
Plaque rupture in non-obstructive lesions of non-IRAs was present in 12% of AMI patients. Larger plaque volume, positive remodeling, and thinner fibrous cap were associated with rupture. More than half of untreated ruptures transitioned into stable morphologies. Thin-cap fibroatheroma was the most frequent underlying morphology of new-onset rupture.