A Japanese study published in the sub-blog of JACCh showed that in patients who did not undergo revascularization, the increase in plaque load on the left backbone (>5 years) was associated with long-term (>5 years) all-cause death and cardiogenic death, even if the left backbone lumen area is retained.
This study analyzed a total of 3239 patients who underwent left main vascular ultrasound (IVUS) but did not undergo revascularization. The main ones were stable or unstable angina. Only 11% of them had acute coronary syndrome with or without ST segment elevation. The average lumen area of the left backbone measured by
IVUS was 13.1 mm2, the average plaque load was 41.7%, and the average follow-up was 8.2 years.
results show that the 12-year all-cause mortality rate was 37.5%, and the cardiac mortality rate was 17%. Among them, the 12-year all-cause mortality rate was 28% to 46%.
In the analysis of uncorrected related factors, the left main trunk plaque load increased by 17% all-cause risk of death.
After considering clinical and imaging characteristics, plaque burden is an independent predictor of all-cause death and cardiogenic death, with a 12% increase in plaque burden.
After considering phase clinical factors, angiography and intravascular ultrasound factors, the heavier plaque load on the left main trunk increased by 12% all-cause death risk. The results for cardiac death are similar.
In patients with minimal tube lumen area (MLA) 6 mm2 (about 4% of the cohort), the study results remained.
Models predicting plaque burden based on comorbidity and demographic characteristics show that age-enhanced, diabetes , male and hypertension are associated with higher plaque burden.
The same-term commentary pointed out that coronary artery disease is a vascular wall disease, not a vascular lumen disease. Depending on the development of the disease, a large outward expansion of the blood vessel wall can accommodate a large number of plaques without limiting the size of the lumen and the flow through it.
So when there is no stenosis of the blood vessel, should the left main artery atherosclerosis be screened for? There is no answer yet.
In addition, for patients with obvious plaques on the left trunk, more active treatment plans should be adopted instead of routine treatment, or more clinically significant .
Source: Masahiko Noguchi, et al. Impact of Non-obstructive Left Main Coronary Artery Atherosclerosis on Long-Term Mortality. J Am Coll Cardiol Intv. Oct 12, 2022.
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