Three-Vessel Intravascular OCT Evaluation of Coronary Plaque Burden and Phenotype

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  JACC: Advances  https://doi.org/10.1016/j.jacadv.2026.102983  
Dr. Jakub Chmiel  et al.

Points

Mass General Brigham investigators evaluated 534 coronary plaques across 131 patients using three-vessel high-resolution optical coherence tomography.
High-resolution imaging demonstrated that individuals with a higher modifiable risk factor burden exhibited extensive plaque buildup across all major coronary arteries.
Modifiable risk factors including hypertension, hyperlipidemia, diabetes, smoking, and obesity directly correlated with vulnerable, thin-cap fibroatheromas prone to acute rupture.
Non-modifiable factors such as age, biological sex, and family history were associated with more stable coronary plaque phenotypes.
Findings highlight the clinical necessity for early, aggressive, and sustained risk-factor management to prevent coronary plaque destabilization and sudden cardiac death.

Summary

This study evaluated the association between modifiable and non-modifiable cardiovascular risk factors (RFs) and pan-coronary plaque burden, phenotype, and vulnerability across all three major coronary arteries. While traditional cardiovascular risk factors are widely used to predict future ischemic events, including acute coronary syndromes (ACS), the precise relationship between modifiable risk burden and multi-vessel plaque morphology remains incompletely defined. The research sought to determine if higher modifiable risk factor burden directly correlates with increased diffuse plaque burden and vulnerable plaque characteristics prone to rupture.

Using high-resolution intravascular optical coherence tomography (OCT), the study evaluated 534 discrete atherosclerotic plaques across 131 patients who underwent three-vessel coronary imaging. Intravascular morphological assessment quantified plaque distribution, fibrous cap thickness, lipid core burden, and structural stability across all major epicardial coronary vessels. The analysis stratified risk burden by evaluating modifiable parameters—including hypertension, hyperlipidemia, diabetes mellitus, active tobacco use, and obesity—alongside non-modifiable factors such as age, biological sex, and family history of premature coronary artery disease.

Phenotypic analysis revealed that patients with a higher burden of modifiable risk factors exhibited significantly greater multi-vessel plaque burden and a higher frequency of vulnerable plaque features, notably thin-cap fibroatheromas with rich lipid pools susceptible to disruption. Conversely, non-modifiable risk factors were predominantly associated with more stable plaque phenotypes characterized by thick fibrous caps and calcification. These findings demonstrate that modifiable risk factors accelerate pan-coronary atherogenesis and destabilize plaque morphology, reinforcing the clinical necessity for early, aggressive, and sustained risk-factor modification to prevent acute coronary events.

Link to the article: https://www.jacc.org/doi/10.1016/j.jacadv.2026.102983

References

Chmiel, J., Andreaggi, S., Kim, S., McNulty, I., Lee, H., Banning, A. P., Bryniarski, K. L., Musialek, P., & Jang, I.-K. (2026). Association between cardiovascular risk factors and pan-coronary plaque burden, phenotype, and vulnerability. JACC: Advances, 102983. https://doi.org/10.1016/j.jacadv.2026.102983