A total of 434 patients presented with STEMI and underwent OCT imaging of native culprit vessels between March 2017 and March 2019. After applying the inclusion criteria, 160 patients were excluded because of a lack of pre-intervention OCT examinations (n = 8), low-quality OCT images due to a massive thrombus (n = 87), in-stent restenosis (n = 34), coronary spasm (n = 11), coronary embolism (n = 2), calcified nodule (n = 17), and absence of follow-up data (n = 1). Consequently, a total of 274 patients were enrolled in this study. A flow diagram illustrating the study sample selection is presented in Fig. 2.
Baseline clinical and angiographic data
Table 1 summarizes the baseline clinical and angiographic characteristics stratified by rSS levels and TCFA (group 0: rSS ≤ median and TCFA = 0, N = 108; group 1: rSS ≤ median and TCFA = 1, N = 32; group 2: rSS > median and TCFA = 0, N = 97; group 3: rSS > median and TCFA = 1, N = 37). The mean age of the study participants was 58.0 years, and 80.7% were males. Most participants were considered to have traditional risk factors for cardiovascular disease such as hypertension (59.9%), hyperlipidemia (86.1%), and current smoking (68.2%), while only 28.5%, 8%, and 4.7% of the enrolled patients had a history of diabetes mellitus (DM), PCI, and peripheral atherosclerosis, respectively. The high rSS with TCFA group (rSS > median and TCFA = 1) consisted of more male patients (94.6% vs. 85.2%/71.9%/73.2%) and had a higher MACE incidence (35.1% vs. 12.0%/12.5%/18.6%) at a median follow-up of 1.98 years (712.52 days). Other baseline characteristics were not statistically different among the four groups. Representative OCT images are shown in Fig. 1.
Table 1
Baseline clinical characteristics of the study population
Variables
|
Total (N = 274)
|
Group = 0
(TCFA absent &Rss ≤ 4)
|
Group = 1
(TCFA present &Rss ≤ 4)
|
Group = 2
(TCFA absent &Rss > 4)
|
Group = 3
(TCFA present &Rss > 4)
|
P value
|
Age (years)
|
58.0 (50.0, 67.0)
|
55.0 (49.0, 64.5)
|
61.5 (54.8, 72.0)
|
61.0 (51.0, 68.0)
|
59.0 (50.0, 63.0)
|
0.068
|
Male [%(n)]
|
221 (80.7)
|
92 (85.2)
|
23 (71.9)
|
71 (73.2)
|
35 (94.6)
|
0.011*
|
Height (cm)
|
170.0 (165.0, 173.0)
|
170.0 (165.0, 175.8)
|
169.0 (160.0, 172.0)
|
170.0 (165.0, 172.0)
|
170.0 (167.0, 172.0)
|
0.488
|
Weight (kg)
|
75.0 (67.0, 82.2)
|
75.0 (69.2, 82.9)
|
75.0 (69.0, 80.0)
|
72.0 (65.0, 83.0)
|
75.0 (65.0, 81.0)
|
0.751
|
Heart rate (beats per minute)
|
76.0 (65.0, 86.0)
|
80.0 (67.0, 90.0)
|
70.5 (65.0, 78.2)
|
74.0 (64.5, 83.0)
|
77.0 (66.0, 87.0)
|
0.091
|
SBP (mmHg)
|
121.0 (107.0, 134.0)
|
120.0 (106.0, 132.0)
|
111.0 (104.8, 126.0)
|
124.0 (110.0, 136.0)
|
123.0 (110.0, 135.0)
|
0.266
|
DBP(mmHg)
|
79.0 ± 12.3
|
79.4 ± 13.1
|
75.5 ± 10.2
|
78.4 ± 11.8
|
81.8 ± 13.0
|
0.266
|
Syntax score of base
|
16.0 (11.0, 22.5)
|
14.0 (9.0, 20.1)
|
11.5 (8.8, 16.0)
|
19.5 (15.0, 26.5)
|
20.0 (15.0, 26.0)
|
< 0.001
|
Residual syntax score
|
4.0 (0.0, 8.0)
|
0.0 (0.0, 2.0)
|
2.0 (0.0, 2.2)
|
8.0 (5.0, 12.0)
|
9.0 (6.0, 15.0)
|
< 0.001
|
Risk factors
|
|
|
|
|
|
|
Hypertension[%(n)]
|
164 (59.9)
|
59 (54.6)
|
19 (59.4)
|
63 (64.9)
|
23 (62.2)
|
0.501
|
Diabetes[%(n)]
|
78 (28.5)
|
23 (21.3)
|
13 (40.6)
|
27 (27.8)
|
15 (40.5)
|
0.502
|
Hyperlipidemia[%(n)]
|
236 (86.1)
|
93 (86.1)
|
29 (90.6)
|
81 (83.5)
|
33 (89.2)
|
0.781
|
Smoking[%(n)]
|
165 (68.2)
|
60 (63.2)
|
19 (76)
|
58 (65.9)
|
28 (82.4)
|
0.160
|
Previous PCI[%(n)]
|
22 ( 8.0)
|
8 (7.4)
|
5 (15.6)
|
7 (7.2)
|
2 (5.4)
|
0.433
|
Peripheral atherosclerosis [%(n)]
|
12 ( 4.7)
|
5 (4.9)
|
1 (3.4)
|
4 (4.4)
|
2 (5.7)
|
0.977
|
CKD[%(n)]
|
4 ( 1.6)
|
2 (2)
|
2 (6.9)
|
0 (0)
|
0 (0)
|
0.076
|
Laboratory examinations
|
|
|
|
|
|
|
HDL-cholesterol (mmol/L)
|
1.1 (0.9, 1.2)
|
1.1 (0.9, 1.2)
|
1.2 (1.0, 1.3)
|
1.0 (0.9, 1.2)
|
1.1 (0.8, 1.2)
|
0.215
|
LDL-cholesterol at (mmol/L)
|
2.8 ± 0.9
|
2.6 ± 0.8
|
3.1 ± 1.0
|
2.8 ± 0.9
|
3.0 ± 0.8
|
0.014*
|
Triglycerides (mmol/L)
|
1.4 (1.0, 2.0)
|
1.4 (0.9, 1.9)
|
1.4 (1.0, 1.8)
|
1.4 (1.0, 2.1)
|
1.7 (1.0, 2.5)
|
0.29
|
LPA (mg/L)
|
159.1 (71.5, 376.1)
|
166.5 (70.8, 378.8)
|
127.2 (84.1, 250.2)
|
159.2 (66.0, 389.6)
|
183.0 (75.0, 419.0)
|
0.841
|
hs-CRP (mg/L)
|
6.2 (2.7, 10.9)
|
6.2 (2.9, 11.1)
|
3.4 (1.7, 8.6)
|
5.9 (2.6, 10.9)
|
6.7 (3.2, 10.8)
|
0.194
|
D-dimer (ug/mL)
|
0.2 (0.1, 0.4)
|
0.2 (0.1, 0.4)
|
0.2 (0.1, 0.3)
|
0.2 (0.1, 0.4)
|
0.3 (0.2, 0.6)
|
0.268
|
TnI (ng/L)
|
0.9 (0.1, 5.2)
|
1.3 (0.1, 5.4)
|
0.8 (0.0, 3.4)
|
0.8 (0.2, 4.9)
|
0.3 (0.0, 3.8)
|
0.45
|
Peak level of TnI (ng/L)
|
23.9 (10.8, 46.5)
|
25.2 (9.6, 52.1)
|
18.2 (10.3, 32.5)
|
26.2 (11.3, 46.5)
|
19.2 (8.7, 42.8)
|
0.419
|
BNP (ng/L)
|
137.3 (47.9, 566.0)
|
182.0 (60.4, 626.5)
|
170.2 (47.7, 417.1)
|
131.7 (48.0, 571.1)
|
75.9 (33.7, 375.8)
|
0.300
|
Peak level of BNP (ng/L)
|
1606.0 (633.5, 3122.0)
|
1465.0 (602.4, 3164.0)
|
1598.0 (989.5, 2484.0)
|
1779.0 (511.3, 3113.0)
|
1190.0 (867.4, 3122.0)
|
0.955
|
WBC 10^9/L
|
9.8 (8.0, 11.9)
|
10.5 (7.9, 12.6)
|
10.0 (8.7, 11.6)
|
9.6 (8.1, 11.4)
|
9.2 (7.8, 10.9)
|
0.179
|
Hemoglobin
|
147.5 (136.0, 156.0)
|
149.0 (137.8, 156.0)
|
147.0 (136.2, 157.2)
|
147.0 (133.0, 154.0)
|
147.0 (137.0, 157.0)
|
0.635
|
Platelet
|
222.0 (191.2, 280.8)
|
222.0 (190.0, 285.2)
|
231.0 (186.5, 266.0)
|
230.0 (195.0, 281.0)
|
217.0 (190.0, 287.0)
|
0.909
|
Crea (umol/L)
|
79.0 (67.9, 91.8)
|
78.1 (67.1, 94.4)
|
83.1 (69.2, 91.7)
|
77.7 (66.0, 88.0)
|
82.2 (73.4, 92.4)
|
0.234
|
Glu
|
7.6 (6.3, 10.0)
|
7.1 (6.3, 9.0)
|
9.0 (7.4, 10.2)
|
7.7 (6.1, 10.3)
|
7.8 (6.5, 11.8)
|
0.082
|
ALC
|
6.0 (5.6, 7.1)
|
5.8 (5.5, 6.6)
|
6.2 (5.8, 7.9)
|
6.1 (5.6, 7.1)
|
6.2 (5.6, 7.7)
|
0.097
|
Discharge medication regimen
|
|
|
|
|
|
|
Aspirin[%(n)]
|
265 (96.70)
|
105 (97.20)
|
31 (96.90)
|
93 (95.90)
|
36 (97.30)
|
0.952
|
Ticagrelor[%(n)]
|
139 (50.70)
|
50 (46.30)
|
22 (68.80)
|
51 (52.60)
|
16 (43.20)
|
0.113
|
Clopidogrel[%(n)]
|
135 (49.30)
|
58 (53.70)
|
10 (31.20)
|
46 (47.40)
|
21 (56.80)
|
0.113
|
ACEI/ARB[%(n)]
|
204 (74.50)
|
83 (76.90)
|
24 (75)
|
67 (69.10)
|
30 (81.10)
|
0.447
|
Beta-Blockers[%(n)]
|
240 (87.60)
|
95 (88)
|
28 (87.50)
|
84 (86.60)
|
33 (89.20)
|
0.988
|
Statin[%(n)]
|
266 (97.10)
|
104 (96.30)
|
32 (100)
|
93 (95.90)
|
37 (100)
|
0.638
|
Proton pump inhibitor[%(n)]
|
109 (39.80)
|
39 (36.10)
|
16 (50)
|
38 (39.20)
|
16 (43.20)
|
0.532
|
Oral anticoagulants[%(n)]
|
6 ( 2.20)
|
2 (1.90)
|
1 (3.10)
|
3 (3.10)
|
0 (0)
|
0.728
|
Procedural data
|
|
|
|
|
|
|
Angiographic findings
|
|
|
|
|
|
|
Culprit vessels
|
|
|
|
|
|
< 0.001*
|
LAD
|
131 (47.8)
|
69 (63.9)
|
15 (46.9)
|
37 (38.1)
|
10 (27)
|
|
LCX
|
27 ( 9.9)
|
5 (4.6)
|
1 (3.1)
|
18 (18.6)
|
3 (8.1)
|
|
RCA
|
116 (42.3)
|
34 (31.5)
|
16 (50)
|
42 (43.3)
|
24 (64.9)
|
|
Coronary artery lesions
|
|
|
|
|
|
< 0.001*
|
SVD
|
66 (24.1)
|
53 (49.1)
|
9 (28.1)
|
3 (3.1)
|
1 (2.7)
|
|
DVD
|
100 (36.5)
|
36 (33.3)
|
17 (53.1)
|
35 (36.1)
|
12 (32.4)
|
|
TVD
|
108 (39.4)
|
19 (17.6)
|
6 (18.8)
|
59 (60.8)
|
24 (64.9)
|
|
Pre-TIMI flow
|
|
|
|
|
|
0.793
|
0
|
172 (62.8)
|
71 (65.7)
|
19 (59.4)
|
62 (63.9)
|
20 (54.1)
|
|
1
|
15 ( 5.5)
|
5 (4.6)
|
1 (3.1)
|
6 (6.2)
|
3 (8.1)
|
|
2
|
25 ( 9.1)
|
9 (8.3)
|
5 (15.6)
|
9 (9.3)
|
2 (5.4)
|
|
3
|
62 (22.6)
|
23 (21.3)
|
7 (21.9)
|
20 (20.6)
|
12 (32.4)
|
|
AHA classification
|
|
|
|
|
|
0.793
|
A
|
2 ( 0.7)
|
0 (0)
|
0 (0)
|
1 (1)
|
1 (2.7)
|
|
B1
|
25 ( 9.2)
|
11 (10.2)
|
3 (9.4)
|
6 (6.2)
|
5 (13.5)
|
|
B2
|
38 (13.9)
|
16 (14.8)
|
4 (12.5)
|
13 (13.5)
|
5 (13.5)
|
|
C
|
208 (76.2)
|
81 (75)
|
25 (78.1)
|
76 (79.2)
|
26 (70.3)
|
|
Diameter of lesion
|
3.0 (2.8, 3.5)
|
3.0 (3.0, 3.5)
|
3.3 (3.0, 3.5)
|
3.0 (2.7, 3.5)
|
3.0 (3.0, 3.5)
|
0.033*
|
Length of lesion
|
26.0 (19.0, 37.0)
|
24.0 (17.8, 34.2)
|
29.0 (21.5, 42.8)
|
27.0 (21.0, 36.2)
|
30.0 (18.0, 35.0)
|
0.143
|
Endpoint events
|
|
|
|
|
|
|
MACE [%(n)]
|
48 (17.5)
|
13 (12)
|
4 (12.5)
|
18 (18.6)
|
13 (35.1)
|
0.013*
|
Death [%(n)]
|
2 ( 0.70)
|
0 (0)
|
0 (0)
|
1 (10)
|
1 (2.70)
|
0.339
|
Recurrent MI [%(n)]
|
8 ( 2.90)
|
1 (0.90)
|
0 (0)
|
4 (4.10)
|
3 (8.10)
|
0.082
|
Stroke [%(n)]
|
9 ( 3.30)
|
4 (3.70)
|
2 (6.20)
|
2 (2.10)
|
1 (2.70)
|
0.618
|
Revascularization
|
37 (13.5)
|
9 (8.3)
|
2 (6.2)
|
15 (15.5)
|
11 (29.7)
|
0.012*
|
Heart failure [%(n)]
|
6 ( 2.20)
|
3 (2.80)
|
0 (0)
|
3 (3.1)
|
0 (0)
|
0.768
|
Continuous data are presented as median (interquartile range). Categorical data are presented as number (%). DM, diabetes mellitus; SBP, systolic blood pressure; DBP, diabetes blood pressure; PCI, percutaneous coronary intervention; CKD, chronic kidney disease; HDL, high density lipoprotein; LDL, low density lipoprotein; LPA, lipse activator; hs-CRP, high sensitive C-reactive protein; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; TnI, troponin; LAD, left anterior descending artery; LCX left circumfex artery; RCA right coronary artery; DVD double vessel disease; SVD single vessel disease; TVD triple vessel disease. AHA, American Heart Association; MACE, major adverse cardiovascular events; MI, myocardial infarction. TCFA, thin-cap fibroatheroma; rSS, residual syntax score.*P < 0.05. |
Baseline OCT findings
A comparison of plaque characteristics based on OCT findings among the four groups is presented in Table 2. The rate of plaque rupture in culprit lesions was higher among patients with high rSS and TCFA (group 3) than in those with low rSS without TCFA (group 0) (91.9% vs. 42.6%, P < 0.001). Similarly, the rates of lipid-rich plaques (91.9% vs. 37.0%, P < 0.001) and macrophage infiltration (94.6% vs. 40.7%, P < 0.001) were higher in group 0 than in group 3. However, the rates of fibrous plaques (5.4% vs. 28.2%, P = 0.003) and mixed plaques (2.7% vs. 21.9%, P = 0.004) were lower in the high rSS with TCFA group than in the low rSS without TCFA group. The frequencies of microstructural features such as healing plaques, calcification, microcalcification, microvessels, cholesterol crystals, and thrombus were similar among all three groups, as were quantitative parameters such as the minimal lumen area.
Table 2
Optical coherence tomography characteristics
Variables
|
Total (N = 274)
|
Group = 0
(TCFA absent &Rss ≤ 4)
|
Group = 1
(TCFA present &Rss ≤ 4)
|
Group = 2
(TCFA absent &Rss > 4)
|
Group = 3
(TCFA present &Rss > 4)
|
P value
|
P# for overall
|
P 0 vs 1
|
P 0 vs 2
|
P 0 vs 3
|
P 1 vs 2
|
P 1 vs 3
|
P 2 vs 3
|
Plaque morphology
|
< 0.001 *
|
0.007*
|
0.940
|
< 0.001*
|
0.161
|
0.953
|
< 0.001*
|
Plaque rupture[%(n)]
|
155 (56.6)
|
46 (42.6)
|
24 (75)
|
51 (52.6)
|
34 (91.9)
|
|
|
|
|
|
|
|
Intact fibrous cap[%(n)]
|
119 (43.4)
|
62 (57.4)
|
8 (25)
|
46 (47.4)
|
3 (8.1)
|
|
|
|
|
|
|
|
Lipid-rich plaque[%(n)]
|
141 (51.5)
|
40 (37)
|
25 (78.1)
|
42 (43.3)
|
34 (91.9)
|
< 0.001 *
|
< 0.001 *
|
1.000
|
< 0.001 *
|
0.004*
|
1.000
|
< 0.001 *
|
Fibrous plaque[%(n)]
|
78 (28.5)
|
38 (35.2)
|
2 (6.2)
|
36 (37.1)
|
2 (5.4)
|
< 0.001 *
|
0.009*
|
1.000
|
0.003*
|
0.005*
|
1.000
|
0.002*
|
Mixed plaque [%(n)]
|
60 (21.9)
|
32 (29.6)
|
4 (12.5)
|
23 (23.7)
|
1 (2.7)
|
0.004 *
|
0.240
|
1.000
|
0.004*
|
1.000
|
1.000
|
0.052
|
Healing plaque[%(n)]
|
55 (20.1)
|
15 (13.9)
|
6 (18.8)
|
26 (26.8)
|
8 (21.6)
|
0.145
|
|
|
|
|
|
|
Calcification[%(n)]
|
140 (51.1)
|
48 (44.4)
|
17 (53.1)
|
54 (55.7)
|
21 (56.8)
|
0.354
|
|
|
|
|
|
|
Micro-calcification[%(n)]
|
136 (49.6)
|
47 (43.5)
|
17 (53.1)
|
52 (53.6)
|
20 (54.1)
|
0.445
|
|
|
|
|
|
|
Macrophage[%(n)]
|
149 (54.4)
|
44 (40.7)
|
31 (96.9)
|
39 (40.2)
|
35 (94.6)
|
< 0.001 *
|
< 0.001 *
|
1.000
|
< 0.001 *
|
< 0.001 *
|
1.000
|
< 0.001 *
|
Microvessels[%(n)]
|
48 (17.5)
|
20 (18.5)
|
9 (28.1)
|
13 (13.4)
|
6 (16.2)
|
0.290
|
|
|
|
|
|
|
Cholesterol crystal[%(n)]
|
22 ( 8.0)
|
7 (6.5)
|
3 (9.4)
|
7 (7.2)
|
5 (13.5)
|
0.520
|
|
|
|
|
|
|
Thrombus[%(n)]
|
271 (98.9)
|
106 (98.1)
|
32 (100)
|
96 (99)
|
37 (100)
|
1.000
|
|
|
|
|
|
|
Minimal FCT, um
|
100.0 (60.0, 120.0)
|
100.0 (90.0, 150.0)
|
60.0 (50.0, 60.0)
|
110.0 (90.0, 140.0)
|
60.0 (50.0, 60.0)
|
< 0.001 *
|
< 0.001 *
|
1.000
|
< 0.001 *
|
< 0.001 *
|
1.000
|
< 0.001 *
|
Maximal lipid arc, °
|
360.0 (248.0, 360.0)
|
360.0 (242.0, 360.0)
|
360.0 (360.0, 360.0)
|
293.0 (230.0, 360.0)
|
360.0 (360.0, 360.0)
|
< 0.001 *
|
0.031*
|
1.000
|
0.005*
|
0.001*
|
1.000
|
< 0.001*
|
MLA, mm2
|
1.7 (1.4, 2.2)
|
1.6 (1.4, 2.2)
|
2.0 (1.6, 2.7)
|
1.6 (1.3, 2.1)
|
1.9 (1.6, 2.3)
|
0.022 *
|
0.088
|
1.000
|
0.742
|
0.043*
|
1.000
|
0.418
|
Continuous data are presented as median (interquartile range). Categorical variables are presented as number (%). TCFA, thin-cap fibroatheroma; rSS, residual syntax score; FCT fibrous cap thickness; MLA minimal lumen area *P < 0.05, # P for overall means statistical analysis among four groups |
Findings with Cox regression models in subgroups
Cox regression models indicated that the hazard ratio (HR) for MACEs was higher in patients with high rSS and TCFA than in patients with low rSS without TCFA (Table 3). The Kaplan–Meier curves for the crude prediction of revascularization, MACE and MACEs plus heart failure are presented in Supplementary Fig. 1. The high rSS with TCFA group had a higher incidence of MACEs (HR, 1.45; 95% confidence interval [CI], 1.13–2.08; P = 0.002) than the low rSS without TCFA group, and additional adjustment for other variables such as sex, age, ejection fraction, smoking, hypertension, hyperlipidemia, DM, WBC count, hemoglobin, platelet count, creatine kinase, glucose, glycosylated hemoglobin, and C-reactive protein did not alter the significant difference. However, a similar significant difference among the other subgroups was not observed. Further, multiple comparisons revealed that the incidences of stroke and angina pectoris were not significantly different among the subgroups. While the HR increased with an increase in rSS among patients without TCFA (Supplemental Fig. 2A), this tendency was not observed with an increase in rSS among patients with TCFA (curve fitting with Cox regression models; Supplementary Fig. 2B).
Table 3
Association between separate endpoints survival and groups which divided by TCFA and rSS in all enrolled patients
|
Crude model
|
Adjust model I
|
Adjust model II
|
Adjust model III
|
Group
|
crude HR(95%CI)
|
crude P value
|
Adj I. HR(95%CI)
|
Adj. P value
|
Adj II. HR(95%CI)
|
Adj. P value
|
Adj III. HR(95%CI)
|
Adj. P value
|
MACE
|
|
|
|
|
|
|
|
|
0
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1
|
1.09 (0.35,3.34)
|
0.884
|
0.94 (0.3,2.91)
|
0.915
|
1.14 (0.35,3.72)
|
0.832
|
1.28 (0.38,4.29)
|
0.692
|
2
|
1.53 (0.75,3.12)
|
0.244
|
1.36 (0.66,2.80)
|
0.404
|
1.50 (0.68,3.31)
|
0.315
|
1.62 (0.73,3.60)
|
0.233
|
3
|
3.21 (1.49,6.93)
|
0.003*
|
3.20 (1.47,6.96)
|
0.003*
|
3.79 (1.55,9.26)
|
0.003*
|
4.19 (1.69,10.41)
|
0.002*
|
Trend test
|
1.44 (1.1,1.87)
|
0.007*
|
1.42 (1.08,1.86)
|
0.011*
|
1.49 (1.1,2.02)
|
0.010*
|
1.53 (1.13,2.08)
|
0.006*
|
Stroke
|
|
|
|
|
|
|
|
|
0
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1
|
1.84 (0.34,10.05)
|
0.483
|
1.38 (0.24,7.83)
|
0.713
|
1.26 (0.19,8.32)
|
0.808
|
1.52 (0.21,11.21)
|
0.682
|
2
|
0.52 (0.09,2.84)
|
0.449
|
0.41 (0.07,2.27)
|
0.304
|
0.37 (0.06,2.17)
|
0.27
|
0.38 (0.06,2.40)
|
0.303
|
3
|
0.68 (0.08,6.11)
|
0.733
|
0.62 (0.07,5.62)
|
0.674
|
0.61 (0.06,6.34)
|
0.682
|
0.83 (0.08,8.95)
|
0.879
|
Trend test
|
0.8 (0.44,1.47)
|
0.477
|
0.74 (0.4,1.39)
|
0.349
|
0.71 (0.36,1.38)
|
0.314
|
0.75 (0.38,1.47)
|
0.406
|
Angina
|
|
|
|
|
|
|
|
|
0
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1 (reference)
|
1
|
1.34 (0.36,5.07)
|
0.663
|
1.13 (0.29,4.36)
|
0.857
|
1.3 (0.3,5.5)
|
0.726
|
1.25 (0.28,5.60)
|
0.768
|
2
|
0.79 (0.27,2.27)
|
0.659
|
0.67 (0.23,1.97)
|
0.467
|
0.69 (0.22,2.21)
|
0.533
|
0.62 (0.19,2.06)
|
0.434
|
3
|
1.39 (0.42,4.61)
|
0.594
|
1.51 (0.44,5.1)
|
0.511
|
1.45 (0.38,5.46)
|
0.586
|
1.41 (0.36,5.52)
|
0.621
|
Trend test
|
1.02 (0.7,1.5)
|
0.914
|
1.00 (0.67,1.50)
|
0.983
|
0.99 (0.65,1.54)
|
0.998
|
0.98 (0.63,1.52)
|
0.915
|
Notes: data presented are HRs and 95% CI. Adjust I model adjusts for sex and age; Adjust II model adjusts for adjust I plus ejection fraction, smoke, hypertension, hyperlipidemia, diabetes mellitus; Adjust III model adjusts for adjust II + white blood cell, hemoglobin, platelet, creatine kinase, glucose, glycosylated hemoglobin, C-reactive protain. TCFA, thin-cap fibroatheroma; rSS, residual syntax score; Adj., adjusted; MACE, major adverse cardiovascular events *P < 0.05. |
Table 4 shows the crude and adjusted multivariable relationships between MACEs stratified according to levels of rSS divided into subgroups according to characteristics on OCT. In patients without TCFA, increasing tertiles of rSS levels were associated with a higher cumulative incidence of MACEs over time (P for trend = 0.005). Nevertheless, in those with TCFA, increasing tertiles of rSS levels were not associated with a higher incidence of MACE risk over time in a stepwise manner (P for trend = 0.947). In the group without TCFA, the HR for MACEs among patients with high rSS was 5.85-fold higher than that among patients with low rSS in the fully adjusted Cox regression models (P = 0.004). Similarly, in the group with plaque erosion, the HR for MACEs among patients with high rSS was 3.63-fold higher than that among patients with low rSS in the fully adjusted Cox regression models (P = 0.034). Furthermore, among patients with macrophage infiltration, the HR for MACEs in the high rSS group was 4.12-fold higher than that in the low rSS group in the crude model, and additional adjustment for other variables did not change the significance of high rSS with respect to MACEs (HR, 6.6; 95% CI, 1.24–35.02; P = 0.027). Further comparisons revealed that increasing tertiles of rSS levels were associated with a higher cumulative incidence of MACEs over time (P for trend = 0.026) in the subgroup with macrophage infiltration in culprit plaques. However, no significant difference between subgroups without macrophage infiltration was noted. In patients with calcification, microcalcification, and absence of lipid-rich plaques, increasing tertiles of rSS levels were associated with a higher cumulative incidence of MACEs over time (P for trend = 0.002, 0.007, and 0.012, respectively). In those with plaque rupture, lipid-rich plaques, and mixed plaques, increasing tertiles of rSS levels were not associated with a higher cumulative incidence of MACEs over time (P for trend = 0.111,0.126, and 0.076, respectively).
Table 4
Association of rSS with MACE in enrolled patients according to subgroup of characteristics by OCT
Variables
|
MACE /Total
|
Crude model
|
Adjusted model I
|
Adjust model II
|
Adjust model III
|
crude HR(95%CI)
|
crude P value
|
Adj I. HR(95%CI)
|
Adj. P value
|
adj. HR(95%CI)
|
Adj. P value
|
adj. HR(95%CI)
|
Adj. P value
|
TCFA = 0
|
rSSlow
|
7 (12.10)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
13 (13.10)
|
1.03 (0.41,2.59)
|
0.944
|
0.98 (0.39,2.46)
|
0.963
|
1.04 (0.38,2.86)
|
0.942
|
1.32 (0.45,3.88)
|
0.613
|
rSShigh
|
11 (22.90)
|
1.99 (0.77,5.15)
|
0.153
|
1.96 (0.76,5.07)
|
0.164
|
2.86 (0.99,8.27)
|
0.053
|
5.85 (1.78,19.28)
|
0.004*
|
Trend test
|
31 (15.1)
|
1.46 (0.88,2.42)
|
0.139
|
1.46 (0.88,2.43)
|
0.145
|
1.79 (1,3.21)
|
0.049
|
2.52 (1.32,4.81)
|
0.005*
|
TCFA = 1
|
rSSlow
|
1 (7.10)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
9 (25.70)
|
4.28 (0.54,33.82)
|
0.168
|
4.20 (0.53,33.58)
|
0.176
|
6.97 (0.78,62.52)
|
0.083
|
11.14 (0.44,279.13)
|
0.142
|
rSShigh
|
7 (35.00)
|
5.51 (0.68,44.83)
|
0.110
|
5.94 (0.72,48.76)
|
0.097
|
3.94 (0.45,34.81)
|
0.217
|
2.3 (0.13,40.85)
|
0.570
|
Trend test
|
17 (24.6)
|
1.81 (0.89,3.68)
|
0.100
|
1.96 (0.93,4.14)
|
0.078
|
1.41 (0.68,2.9)
|
0.356
|
1.04 (0.34,3.18)
|
0.947
|
Plaque erosion
|
rSSlow
|
5 (12.50)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
6 (10.90)
|
0.83 (0.25,2.71)
|
0.752
|
0.71 (0.21,2.43)
|
0.591
|
0.95 (0.25,3.69)
|
0.945
|
1.86 (0.29,11.92)
|
0.512
|
rSShigh
|
4 (16.70)
|
1.4 (0.38,5.22)
|
0.615
|
1.16 (0.3,4.51)
|
0.834
|
2.92 (0.6,14.18)
|
0.184
|
14.57 (1.22,173.3)
|
0.034*
|
Trend test
|
15 (12.60)
|
1.16 (0.57,2.36)
|
0.681
|
1.06 (0.51,2.22)
|
0.879
|
1.7 (0.71,4.05)
|
0.234
|
3.63 (1.03,12.86)
|
0.045*
|
Plaque rupture
|
rSSlow
|
3 (9.40)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
16 (20.30)
|
2.26 (0.66,7.77)
|
0.194
|
2.15 (0.63,7.41)
|
0.223
|
1.69 (0.47,6.07)
|
0.421
|
1.36 (0.34,5.44)
|
0.663
|
rSShigh
|
14 (31.80)
|
3.8 (1.09,13.23)
|
0.036*
|
3.81 (1.09,13.38)
|
0.037*
|
3.06 (0.82,11.34)
|
0.095
|
2.65 (0.62,11.22)
|
0.186
|
Trend test
|
33 (21.30)
|
1.84 (1.10,3.10)
|
0.021*
|
1.88 (1.11,3.20)
|
0.020*
|
1.77 (0.98,3.2)
|
0.059
|
1.73 (0.88,3.4)
|
0.111
|
Without Macrophage
|
rSSlow
|
5 (14.7)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
10 (15.4)
|
0.98 (0.33,2.87)
|
0.971
|
0.94 (0.32,2.8)
|
0.912
|
0.78 (0.22,2.8)
|
0.708
|
0.67 (0.17,2.62)
|
0.568
|
rSShigh
|
6 (23.1)
|
1.53 (0.47,5.02)
|
0.483
|
1.55 (0.47,5.1)
|
0.471
|
1.74 (0.43,7.03)
|
0.435
|
1.84 (0.36,9.43)
|
0.462
|
Trend test
|
21 (16.8)
|
1.25 (0.67,2.35)
|
0.485
|
1.26 (0.67,2.39)
|
0.470
|
1.36 (0.62,2.96)
|
0.443
|
1.3 (0.52,3.25)
|
0.577
|
With Macrophage
|
rSSlow
|
3 (7.9)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
12 (17.4)
|
2.31 (0.65,8.20)
|
0.194
|
2.4 (0.67,8.64)
|
0.179
|
3.37 (0.83,13.61)
|
0.088
|
4.99 (1.05,23.72)
|
0.043*
|
rSShigh
|
12 (28.6)
|
4.12 (1.16,14.62)
|
0.028*
|
4.26 (1.2,15.13)
|
0.025*
|
4.76 (1.19,18.97)
|
0.027*
|
6.6 (1.24,35.02)
|
0.027*
|
Trend test
|
27 (18.1)
|
1.95 (1.12,3.38)
|
0.017*
|
1.97 (1.13,3.42)
|
0.016*
|
1.96 (1.08,3.56)
|
0.027*
|
2.39 (1.11,5.13)
|
0.026*
|
Without Calcification
|
rSSlow
|
6 (13.6)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
9 (14.1)
|
0.99 (0.35,2.78)
|
0.982
|
0.86 (0.3,2.45)
|
0.776
|
0.95 (0.3,2.96)
|
0.93
|
1.13 (0.34,3.74)
|
0.847
|
rSShigh
|
9 (34.6)
|
2.87 (1.02,8.05)
|
0.046*
|
2.77 (0.98,7.81)
|
0.054
|
2.72 (0.76,9.8)
|
0.126
|
2.41 (0.6,9.67)
|
0.214
|
Trend test
|
24 (17.9)
|
1.79 (1,3.18)
|
0.049*
|
1.79 (0.99,3.23)
|
0.055
|
1.72 (0.84,3.49)
|
0.135
|
1.55 (0.75,3.2)
|
0.235
|
With Calcification
|
rSSlow
|
2 (7.1)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
13 (18.6)
|
2.72 (0.61,12.07)
|
0.189
|
2.83 (0.63,12.65)
|
0.172
|
3.68 (0.75,18.01)
|
0.107
|
6.88 (1.02,46.59)
|
0.048*
|
rSShigh
|
9 (21.4)
|
3.15 (0.68,14.59)
|
0.142
|
3.31 (0.71,15.37)
|
0.127
|
5.06 (1,25.61)
|
0.05
|
23.25 (2.81,192.71)
|
0.004*
|
Trend test
|
24 (17.1)
|
1.53 (0.84,2.76)
|
0.162
|
1.55 (0.86,2.81)
|
0.144
|
1.92 (1.01,3.67)
|
0.048
|
4.18 (1.72,10.16)
|
0.002*
|
Without Micro-calcification
|
rSSlow
|
6 (13.6)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
9 (13.4)
|
0.93 (0.33,2.62)
|
0.895
|
0.79 (0.28,2.26)
|
0.663
|
0.85 (0.27,2.65)
|
0.779
|
0.92 (0.28,3)
|
0.894
|
rSShigh
|
10 (37)
|
3.03 (1.1,8.35)
|
0.032
|
2.81 (1.01,7.8)
|
0.047*
|
2.67 (0.75,9.43)
|
0.128
|
2.44 (0.62,9.62)
|
0.201
|
Trend test
|
25 (18.1)
|
1.89 (1.06,3.35)
|
0.03
|
1.87 (1.03,3.37)
|
0.038*
|
1.74 (0.86,3.52)
|
0.126
|
1.56 (0.75,3.26)
|
0.234
|
With Micro-calcification
|
rSSlow
|
2 (7.1)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
13 (19.4)
|
2.94 (0.66,13.07)
|
0.156
|
3.09 (0.69,13.78)
|
0.140
|
3.92 (0.81,19.08)
|
0.09
|
6.82 (1.06,44)
|
0.044
|
rSShigh
|
8 (19.5)
|
2.93 (0.62,13.8)
|
0.174
|
3.14 (0.66,14.86)
|
0.150
|
4.39 (0.85,22.76)
|
0.078
|
16.84 (2.03,139.54)
|
0.009*
|
Trend test
|
23 (16.9)
|
1.44 (0.8,2.6)
|
0.229
|
1.48 (0.82,2.68)
|
0.193
|
1.76 (0.91,3.37)
|
0.091
|
3.46 (1.41,8.48)
|
0.007*
|
Without lipid plaque
|
rSSlow
|
5 (11.6)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
10 (16.4)
|
1.35 (0.46,3.94)
|
0.586
|
1.32 (0.45,3.88)
|
0.613
|
1.71 (0.51,5.65)
|
0.383
|
3.16 (0.71,14.08)
|
0.132
|
rSShigh
|
6 (20.7)
|
1.8 (0.55,5.91)
|
0.331
|
1.72 (0.52,5.69)
|
0.373
|
3.7 (0.97,14.09)
|
0.055
|
10.48 (1.68,65.48)
|
0.012*
|
Trend test
|
21 (15.8)
|
1.34 (0.74,2.43)
|
0.330
|
1.31 (0.72,2.38)
|
0.372
|
1.93 (0.98,3.83)
|
0.059
|
3.24 (1.29,8.11)
|
0.012*
|
With lipid plaque
|
rSSlow
|
3 (10.3)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
12 (16.4)
|
1.67 (0.47,5.93)
|
0.426
|
1.6 (0.45,5.7)
|
0.465
|
1.27 (0.33,4.82)
|
0.728
|
1.25 (0.29,5.34)
|
0.767
|
rSShigh
|
12 (30.8)
|
3.39 (0.96,12.02)
|
0.059
|
3.45 (0.97,12.25)
|
0.056
|
2.64 (0.69,10.13)
|
0.158
|
2.33 (0.48,11.26)
|
0.291
|
Trend test
|
27 (19.1)
|
1.9 (1.07,3.4)
|
0.029*
|
1.95 (1.08,3.52)
|
0.026
|
1.75 (0.91,3.37)
|
0.094
|
1.62 (0.75,3.47)
|
0.216
|
Without mixed plaque
|
rSSlow
|
4 (8.7)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
18 (17.3)
|
2.01 (0.68,5.94)
|
0.207
|
1.22 (0.5,2.96)
|
0.667
|
1.81 (0.6,5.44)
|
0.294
|
2.03 (0.64,6.46)
|
0.232
|
rSShigh
|
13 (28.3)
|
3.56 (1.16,10.92)
|
0.026*
|
2.5 (1.04,6.05)
|
0.041*
|
2.46 (0.76,7.96)
|
0.132
|
2.91 (0.8,10.65)
|
0.106
|
Trend test
|
35 (17.9)
|
1.85 (1.12,3.06)
|
0.017*
|
1.67 (1.07,2.62)
|
0.025*
|
1.52 (0.89,2.59)
|
0.126
|
1.65 (0.9,3.01)
|
0.105
|
With mixed plaque
|
rSSlow
|
4 (15.4)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
1(reference)
|
rSSmid
|
4 (13.3)
|
0.81 (0.2,3.26)
|
0.772
|
2.94 (0.35,24.81)
|
0.321
|
1.07 (0.18,6.23)
|
0.941
|
1.24 (0.06,26.5)
|
0.891
|
rSShigh
|
5 (22.7)
|
1.48 (0.4,5.52)
|
0.558
|
1.12 (0.07,19.32)
|
0.937
|
5.05 (0.95,26.95)
|
0.058
|
14.66 (0.65,330.23)
|
0.091
|
Trend test
|
13 (16.7)
|
1.24 (0.61,2.5)
|
0.553
|
1.08 (0.37,3.14)
|
0.881
|
2.44 (0.99,6.01)
|
0.054
|
4.67 (0.85,25.7)
|
0.076
|
Adjust I model adjusts for sex and age; Adjust II model adjusts for adjust I plus ejection fraction, smoke, hypertension, hyperlipidemia, diabetes mellitus and killip classification; Adjust III model adjusts for adjust II + white blood cell, hemoglobin, platelet, creatine kinase, glucose, glycosylated hemoglobin, C-reactive protein, low density lipoprotein. |
rSSlow represent rSS = 0; rSSmid represent 0 < rSS ≤ 8, rSShigh represent rSS > 8. rSS, residual syntax score. |
*P < 0.05. |
Table 5 and Supplementary Fig. 3 present the stratified analysis of MACEs at a median follow-up of 1.98 years in all enrolled patients, divided according to TCFA and rSS levels. In the non-DM subgroup, the incidence of MACEs increased by 54% among patients with high rSS and TCFA (group 3), as compared to group 0 (HR: 1.54 [1.06, 2.26]). The tendency was similar in the subgroups of age < median (HR: 6.88 [1.37, 34.63]), ejection fraction ≥ 50% (HR: 3.25 [1.19, 8.84]), current smoking (HR: 4.11 [1.51, 11.19]), platelet count < 300 × 109/L (HR: 4.02 [1.55, 10.45]), and absence of healing plaques (HR: 5.6 [2.11, 14.87]). Notably, in the subgroups of hypertension (P for interaction = 0.012) and WBC count < 10 × 109/L (P for interaction = 0.030), the incidence of MACEs was significantly higher in group 3 than in group 0.
Table 5
Stratified Analysis of MACE at median Follow-up of 1.98 year in all enrolled patients divided by the status of TCFA and level of rSS
|
Status
|
|
|
Confounding factor category
|
Group = 0
(TCFA absent &Rss ≤ 4)
|
Group = 1
(TCFA present &Rss ≤ 4)
|
Group = 2
(TCFA absent &Rss > 4)
|
Group = 3
(TCFA present &Rss > 4)
|
P for trend
|
P for interaction
|
DM
|
|
|
|
|
|
|
without
|
1(reference)
|
1.62 (0.64,4.1)
|
4.13 (1.35,12.61)
|
1.54 (1.06,2.26)
|
0.025*
|
0.226
|
with
|
1(reference)
|
2.48 (0.43,14.38)
|
1.89 (0.36,10)
|
4.28 (0.75,24.44)
|
0.156
|
|
Age
|
|
|
|
|
|
|
< media
|
1(reference)
|
2.93 (0.26,33.31)
|
0.86 (0.13,5.65)
|
6.88 (1.37,34.63)
|
0.088
|
0.490
|
≥ media
|
1(reference)
|
0.86 (0.21,3.54)
|
1.75 (0.68,4.46)
|
3.09 (0.97,9.83)
|
0.039
|
|
EF
|
|
|
|
|
|
|
< 50%
|
1(reference)
|
3.69 (0.01,1086.65)
|
15.65 (0.22,1091.81)
|
21.82 (0.23,2112.96)
|
0.113
|
0.724
|
≥ 50%
|
1(reference)
|
0.83 (0.21,3.19)
|
1.33 (0.54,3.27)
|
3.25 (1.19,8.84)
|
0.037*
|
|
Smoke
|
|
|
|
|
|
|
without
|
1(reference)
|
3.65 (0.49,27.06)
|
4.73 (1.07,20.9)
|
-
|
0.019*
|
0.191
|
with
|
1(reference)
|
0.82 (0.16,4.11)
|
1.18 (0.43,3.24)
|
4.11 (1.51,11.19)
|
0.012*
|
|
Hypertension
|
|
|
|
|
|
|
without
|
1(reference)
|
-
|
4.94 (1.48,16.5)
|
10.46 (1.94,56.45)
|
0.002*
|
0.012*
|
with
|
1(reference)
|
1.08 (0.28,4.23)
|
0.33 (0.09,1.25)
|
2.01 (0.62,6.57)
|
0.826
|
|
History of PCI
|
|
|
|
|
|
|
without
|
1(reference)
|
0.46 (0.06,3.73)
|
1.97 (0.84,4.6)
|
4.84 (1.82,12.88)
|
0.002*
|
0.192
|
with
|
1(reference)
|
-
|
-
|
-
|
0.986
|
|
CRP
|
|
|
|
|
|
|
< 10
|
1(reference)
|
1.76 (0.47,6.66)
|
1.47 (0.56,3.9)
|
6.06 (1.87,19.64)
|
0.017*
|
0.296
|
≥ 10
|
1(reference)
|
-
|
2.29 (0.46,11.5)
|
3.77 (0.59,23.96)
|
0.131
|
|
LPA
|
|
|
|
|
|
|
< 300
|
1(reference)
|
0.92 (0.17,5.02)
|
1.54 (0.52,4.61)
|
7.42 (2.16,25.53)
|
0.006*
|
0.192
|
≥ 300
|
1(reference)
|
4.73 (0.69,32.42)
|
1.78 (0.5,6.37)
|
1.02 (0.21,4.94)
|
0.768
|
|
WBC
|
|
|
|
|
|
|
< 10
|
1(reference)
|
3.8 (0.84,17.27)
|
2.15 (0.7,6.6)
|
8.37 (2.19,31.99)
|
0.011*
|
0.030*
|
≥ 10
|
1(reference)
|
-
|
2.02 (0.57,7.21)
|
6.53 (1.37,31.14)
|
0.027*
|
|
Plt
|
|
|
|
|
|
|
< 300
|
1(reference)
|
0.85 (0.22,3.24)
|
1.34 (0.58,3.13)
|
4.02 (1.55,10.45)
|
0.013*
|
0.499
|
≥ 300
|
1(reference)
|
14.11 (0.51,388.76)
|
5.78 (0.11,300.43)
|
6.95 (0.11,451.72)
|
0.280
|
|
TMAO
|
|
|
|
|
|
|
< media
|
1(reference)
|
-
|
0.72 (0.16,3.35)
|
4.09 (0.34,49.59)
|
0.848
|
0.474
|
≥ media
|
1(reference)
|
7.18 (0.89,58.24)
|
2.6 (0.42,16.11)
|
18.33 (2.92,115.1)
|
0.005*
|
|
Healing plaque
|
|
|
|
|
|
|
without
|
1(reference)
|
0.85 (0.23,3.2)
|
1.55 (0.68,3.52)
|
5.6 (2.11,14.87)
|
0.004*
|
0.197
|
with
|
1(reference)
|
-
|
-
|
-
|
0.580
|
|
Confounding factors including sex, age, ejection fraction, smoke, hypertension, hyperlipidemia, diabetes mellitus, white blood cell, hemoglobin, platelet, creatine kinase, glucose, glycosylated hemoglobin, C-reactive protein. |
TCFA, thin-cap fibroatheroma; rSS, residual syntax score; DM, diabetes mellitus; EF, ejection fraction; CRP, PCI, percutaneous coronary intervention; CRP, C-reactive protein; LPA, lipse activator; WBC, white blood cell; PLT, platelet; TMAO, trimethylamine N-oxide. Adj., adjusted; MACE, major adverse cardiovascular events |
*P < 0.05. |
Diagnostic value of rSS in combination with TCFA
ROC curves were plotted to evaluate the diagnostic value of rSS in combination with morphological characteristics on OCT (particularly TCFA) for predicting MACEs, as compared to traditional risk factors (Fig. 3). The area under the ROC curve for traditional risk factors (including sex, age, ejection fraction, smoking, hypertension, hyperlipidemia, DM, Killip classification, WBC count, hemoglobin, platelet count, creatine kinase, glucose, glycosylated hemoglobin, C-reactive protein, low-density lipoprotein, triglyceride, and lipase activator) was 0.771 (95% CI, 0.716–0.819).
ROC and survival ROC curves for the discriminatory value of MACEs shown in Fig. 3A and Fig. 3B. The area under the ROC curve was 0.794 (95% CI, 0.741–0.840) and 0.816 (95% CI, 0.765–0.860), respectively, whereas the area under the survival ROC curve was 0.798 and 0.846, respectively. The best cutoff values for model III (traditional risk factors + rSS + TCFA) and model IV (traditional risk factors + rSS + TCFA + microstructural features of culprit lesions on OCT) according to the Youden index were 0.5970 and 0.6493, respectively. Therefore, the entire study population was categorized into two groups based on model III: model III ≤ 0.5970 (low model III, n = 257) and model III > 0.5970 (high model III, n = 17). The high model III group had a significantly higher incidence of MACEs for up to a median of 1.98 years than the low model III group (P < 0.001; Fig. 3C). When the entire study population was categorized into two groups based on model IV (model IV ≤ 0.6493 [low model IV, n = 260] and model IV > 0.6493 [high model IV, n = 14]), the high model IV group showed a significantly higher incidence of MACEs than the low model IV group (P < 0.001) (Fig. 3D).
Figure 4 shows the Kaplan–Meier curves for the cumulative incidence of MACEs for up to a median of 1.98 years stratified by rSS levels and TCFA among the subgroups. Among patients without hypertension, the high rSS with TCFA group showed a significantly higher incidence of MACEs than the low rSS without TCFA group (P = 0.0059). However, no significant differences were observed among the other subgroups.