Associations of Thrombotic and Bleeding Risks With Plaque Morphology

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Background: Plaque morphology evaluation using optical coherence tomography (OCT) is vital for planning an optimized strategy for percutaneous coronary intervention (PCI), and an assessment of thrombotic risk (TR) and bleeding risk (BR) is crucial in managing patients who have undergone PCI. We examined the association of TR and BR with plaque morphology in patients with coronary artery disease (CAD).

Methods and Results: We conducted a multicenter prospective observational study and enrolled 325 patients with CAD who underwent PCI with OCT (median age 70 years, 19% women). The calcium index, which is equivalent to the calcium plaque volume, was assessed using OCT. Nondeformable calcified plaque was defined as a calcium score ≥3, the threshold for necessitating aggressive lesion modification. The TR and BR were evaluated using CREDO-Kyoto risk scores. The calcium index and prevalence of nondeformable calcified plaque increased significantly with increasing TR and BR scores. The TR and BR scores were significantly associated with higher calcium index after adjustment for confounders (TR score: β, 0.757; 95% confidence interval [CI], 0.568–0.946; P<0.001 and BR score: β, 0.623; 95% CI, 0.374–0.871; P<0.001). Both the calcium index and prevalence of nondeformable calcified plaque were highest in patients with both high TR and BR.

Conclusions: The TR and BR scores were associated with significant calcification and nondeformable calcified plaques in patients with CAD.