Long-term clinical significance of the presence of puff-chandelier ruptures detected by non-obstructive aortic angioscopy

Although studies have reported various patterns of atherosclerotic aortic plaques (AAPs) detected by non-obstructive aortic angioscopy (NOA), the long-term outcomes associated with AAPs such as puff-chandelier rupture atheromatous plaque (PCR), remain unclear. This study investigated the long-term prognostic significance of AAPs detected by NOA in patients who underwent percutaneous coronary intervention (PCI). This retrospective multicenter cohort study included 167 patients who underwent PCI and NOA. The association between AAPs and the incidence of major adverse cardiac events (MACE) were assessed. MACE was categorized into: MACE1, including cardiac death, myocardial infarction, stroke, and ischemia-driven unplanned revascularization; and MACE2, including cardiac death, myocardial infarction, and stroke. There were no NOA-related complications. Of all AAPs, only PCR showed a significant prognostic value during the follow-up period (mean follow-up period: 6.3 years [range 5.9-6.6]). In multivariable Cox proportional hazards analysis, PCR was an independent predictor of MACE (MACE1; HR 1.91, 95% CI 1.04-3.49, P = 0.04, MACE2; hazard ratio [HR] 4.52, 95% confidence interval [CI] 1.23-16.57, P = 0.02). Kaplan-Meier analysis revealed that PCR was significantly associated with MACE. NOA during PCI is safe and feasible. Detecting PCR by NOA may provide reliable information for identifying patients at high risk of subsequent long-term adverse events after PCI.