Long-term MACEs more likely associated with nonculprit coronary lesions

Nonculprit coronary lesions (NCLs) come with higher long-term risks of major adverse cardiovascular events (MACEs) than culprit lesions (CLs), a recent study has found.

Eighty-two patients (mean age, 60.2±11.6 years; 72 percent male) with NCL, corresponding to 86 lesions, were followed for 10 years for the development of MACEs. Lesions were evaluated using virtual histology-intravascular ultrasound. MACEs were defined as all-cause mortality, myocardial infarction, stroke and revascularization. Outcomes were stratified according to lesion status.

Twenty patients developed MACEs over the study period, yielding an incidence rate of 24.4 percent. The median time to the occurrence of an event was 101.0±46.9 months. Twelve deaths were reported overall, five of which were related to CL or NCL, while the remaining seven were of unknown causes.

The incidence of MACEs related to NCLs was 25.6 percent, developing in 20 patients with 22 lesions. The corresponding rate associated with CLs was 12.8 percent, occurring in 10 patients with 11 lesions. MACEs associated with CLs or NCLs of unknown causes occurred in six participants, resulting in an incidence rate of 7.0 percent.

Ten-year cumulative revascularization was comparable between the intermediate NCLs and CLs (17.4 percent vs 15.1 percent). However, rates were more than doubled when intermediate was compared against minimal NCL (17.4 percent vs 8.1 percent).

“Intermediate NCL can be safely followed up with optimal medical treatment in terms of revascularization risk because this very long-term follow-up study revealed that the chance of revascularization rate was similar between treated CL and untreated intermediate NCL,” said researchers.