Background Intravascular imaging modalities such as optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy allow the detection of vulnerable coronary plaques, which may predict the risk of future major adverse cardiovascular events (MACEs). However, the prognostic relevance of specific plaque characteristics remains incompletely defined. Objectives This updated meta-analysis aimed to identify the most reliable intracoronary imaging-derived parameters for predicting MACE in untreated coronary lesions. Methods A systematic search of PubMed, Scopus and Google Scholar was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) guidelines to identify adjusted observational studies reporting the prognostic impact of plaque vulnerability features assessed by OCT or IVUS. The primary outcome was study-defined MACE. HRs were pooled using random-effects or fixed-effects models depending on heterogeneity. Subgroup and sensitivity analyses were conducted to explore the impact of imaging modality and plaque feature definitions. Results 12 studies including 8453 patients and 22 319 lesions were analysed. All investigated plaque features were significantly associated with an increased risk of MACE. Among predictors, thin-cap fibroatheroma (TCFA) demonstrated the lower positive association (HR 3.06, 95% CI 1.97 to 4.77), while plaque burden showed the highest (HR 3.92, 95% CI 1.45 to 10.59). IVUS-derived parameters (minimum lumen area and high-risk plaque definition) were superior to their OCT counterparts, whereas OCT better discriminated prognostic TCFA. The combination of minimum lumen area, TCFA and lipid arc yielded the strongest predictive performance for MACE risk. Conclusions Intracoronary imaging-derived plaque features are significantly associated with future cardiovascular events. Multiparametric models integrating compositional and morphological features apparently enhance risk stratification compared with single parameters. PROSPERO registration number CRD420251047286.
Improta et al. (Thu,) studied this question.