A NEW pooled analysis has confirmed that high-risk coronary plaques are strongly associated with worse cardiovascular outcomes, regardless of a patient’s baseline clinical risk.
Understanding High-Risk Coronary Plaques
The role of high-risk coronary plaques in driving heart attacks and other cardiac events has long been debated. These unstable fatty deposits within artery walls can rupture and trigger major adverse cardiovascular events, but their rarity and low predictive value have limited their practical use in risk assessment. Researchers from the COMBINE (OCT-FFR) and PECTUS-obs studies sought to determine whether the presence of high-risk coronary plaques added prognostic value beyond traditional clinical risk scores. By combining imaging data and patient information, the study aimed to clarify how plaque features interact with overall cardiovascular risk.
Study Design and Key Findings
This pooled analysis included 810 patients stratified into low (311), intermediate (265), and high (234) risk groups using a modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P). The ability of the TRS-2P score to predict plaque presence was poor (AUC 0.51, 95% CI: 0.47–0.56). However, across all risk levels, patients with high-risk coronary plaques consistently showed worse outcomes.
For major adverse cardiovascular events (MACE) and target lesion failure (TLF), no significant interaction was observed between clinical risk and plaque presence (pinteraction=0.539 for MACE and 0.337 for TLF). The highest TLF event rate per 100 lesion-years was found in high-risk patients with such plaques (6.28, 95% CI: 3.52–10.36), translating to a 13.6% absolute risk at two years. These findings suggest that plaque instability confers additional prognostic weight beyond standard risk factors.
Clinical Implications and Future Directions
This study demonstrates that identifying high-risk coronary plaques using optical coherence tomography could improve risk prediction beyond conventional scoring tools. As high-risk patients with these plaques face elevated event rates, new therapeutic strategies and intensified medical management may be warranted. Future trials are expected to explore whether plaque-targeted interventions could further reduce cardiovascular risk and enhance long-term outcomes.
Reference
Volleberg RH et al. Impact of clinical risk characteristics on the prognostic value of high-risk plaques. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025;21(19):e1147-58.
