{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:57:31Z","timestamp":1777503451948,"version":"3.51.4"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,6,24]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Clinical guidelines recommend different revascularization strategies for nonculprit lesions in patients with ST-segment\u2013elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI). Whether the prevalence of untreated high-risk vulnerable plaques differs in STEMI and NSTEMI and affects their outcomes is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II), a multicenter, prospective natural history study, patients with recent myocardial infarction underwent 3-vessel coronary angiography with coregistered near-infrared spectroscopy and intravascular ultrasound after successful percutaneous coronary intervention of obstructive lesions from 2014 through 2017. Two-feature high-risk plaques were defined as those with both plaque burden \u226570% and maximum lipid core burden index over any 4-mm segment \u2265324.7. The primary end point was major adverse cardiovascular events arising from untreated nonculprit lesions during a median 3.7-year follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Of 898 patients, 199 (22.2%) with 849 nonculprit lesions had STEMI and 699 (77.8%) with 2784 nonculprit lesions had NSTEMI. By intravascular ultrasound, the median nonculprit lesion length was 17.4 mm (interquartile range, 16.3\u201318.5) in STEMI and 17.7 mm (interquartile range, 17.1\u201318.4) in NSTEMI (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.63), and the median minimal lumen area was 5.5 mm\n              <jats:sup>2<\/jats:sup>\n              (interquartile range, 5.3\u20135.7 mm\n              <jats:sup>2<\/jats:sup>\n              ) in STEMI and 5.5 mm\n              <jats:sup>2<\/jats:sup>\n              (interquartile range, 5.3\u20135.6 mm\n              <jats:sup>2<\/jats:sup>\n              ) in NSTEMI (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.99). At the lesion level, the prevalence of 2-feature high-risk nonobstructive nonculprit plaques was slightly higher in patients with STEMI than in patients with NSTEMI (12.8% versus 10.1%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.03). At the patient level, however, the prevalence of 2-feature high-risk plaques was similar in STEMI versus NSTEMI (38.8% versus 32.7%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.11). The prevalence of patients with 1 or more lesions meeting at least 1 high-risk plaque criterion was also similar (plaque burden \u226570%, 63.3% versus 57.8% [\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.16]; maximum lipid core burden index over any 4-mm segment \u2265324.7, 63.3% versus 57.6% [\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.15]). The 4-year rates of nonculprit lesion\u2013related major adverse cardiovascular events were similar in STEMI versus NSTEMI (8.6% versus 7.8%; hazard ratio, 1.02 [95% CI, 0.57\u20131.81];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.95), as were the rates of all major adverse cardiovascular events (14.2% versus 13.0%; hazard ratio, 1.06 [95% CI, 0.68\u20131.64];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.80).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In the PROSPECT II study, the per-patient prevalence of high-risk vulnerable plaques was comparable in STEMI versus NSTEMI, as was the overall long-term incidence of nonculprit lesion\u2013related and all major adverse cardiovascular events. These results support a similar revascularization strategy for nonculprit lesions in patients with STEMI or NSTEMI after culprit lesion management.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02171065.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.124.071980","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T18:00:51Z","timestamp":1750701651000},"page":"1767-1779","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Nonculprit Vulnerable Plaques and Prognosis in Myocardial Infarction With Versus Without ST-Segment Elevation: A PROSPECT II Substudy"],"prefix":"10.1161","volume":"151","clinical-trial-number":[{"clinical-trial-number":"nct02171065","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4692-4252","authenticated-orcid":true,"given":"Pernille G.","family":"Thrane","sequence":"first","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital, Denmark (P.G.T., M. Maeng, H.E.B.)."},{"name":"Department of Clinical Medicine, Aarhus University, Denmark (P.G.T., M. Maeng, H.E.B., O.F.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4310-6433","authenticated-orcid":true,"given":"Michael","family":"Maeng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital, Denmark (P.G.T., M. Maeng, H.E.B.)."},{"name":"Department of Clinical Medicine, Aarhus University, Denmark (P.G.T., M. Maeng, H.E.B., O.F.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1910-8447","authenticated-orcid":true,"given":"Akiko","family":"Maehara","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital and Division of Cardiology, Columbia University Irving Medical Center, New York (A.M., Z.A.A.)."},{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.M., G.S.M., M. Matsumura, L.N.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6358-8962","authenticated-orcid":true,"given":"Hans Erik","family":"B\u00f8tker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital, Denmark (P.G.T., M. Maeng, H.E.B.)."},{"name":"Department of Clinical Medicine, Aarhus University, Denmark (P.G.T., M. Maeng, H.E.B., O.F.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-8705","authenticated-orcid":true,"given":"Gary S.","family":"Mintz","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.M., G.S.M., M. 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