clinical significance of healed plaque detected by optical coherence tomography: a 2-year follow-up study

Recent studies have shown that healed plaque at the culprit lesion detected by optical coherence tomography (oct) is a sign of pan-vascular vulnerability and advanced atherosclerosis. however, the clinical significance of healed plaque is unknown. a total of 265 patients who had oct imaging of a culprit vessel and 2-year clinical follow-up data were included. patients were stratified based on the presence or absence of a layered plaque phenotype, defined as layers of different optical density by oct at either culprit or non-culprit lesions. the association between layered plaque and major adverse cardiac events (mace), defined as cardiac death, acute coronary syndromes (acs), or revascularization, was studied. among 265 patients, 96 (36.2%) had the layered plaque phenotype. layered plaque was more frequently observed in stable angina pectoris patients than in acs patients (57.8%vs. 25.1%, p < 0.001). the average clinical follow-up period was 672 ± 172 days. cumulative mace was significantly higher in patients with layered plaque (p = 0.041), which was primarily driven by the high revascularization rate at 2 years (p = 0.002). multivariate regression analysis showed that presence of layered plaque and low-density lipoprotein cholesterol levels were independently associated with an increased risk of revascularization (p = 0.026, p = 0.008, respectively). patients with healed plaque in the culprit vessel had a higher incidence of revascularization, as compared to those without healed plaque, at 2 years.