Eur Heart J Imaging Methods Pract. 2026 Jun 12;4(1):qyag107. doi: 10.1093/ehjimp/qyag107. eCollection 2026 Jan.
ABSTRACT
AIMS: Macrophages play a crucial role in coronary artery plaque development and can be quantified as circumferential arc features via optical coherence tomography (OCT). However, the prognostic implications of macrophage arc characteristics remain underexplored.
METHODS AND RESULTS: In this multicentre, retrospective study, consecutive patients with coronary artery disease (CAD) undergoing OCT between January 2017 and April 2023 were enrolled. The macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. Among 1025 patients (1173 vessels), 61 (5.9%) experienced major adverse cardiovascular events (MACEs). Receiver operating characteristic analysis identified optimal predictive thresholds: maximum arc ≥ 157.5°, mean arc ≥ 97.88°, and MAS ≥ 2.27 (all P < 0.001). Elevated mean arc [hazard ratio (HR) = 7.628, P < 0.0001], maximum arc (HR = 6.902, P < 0.0001), and MAS (HR = 6.704, P < 0.0001) were independently associated with MACEs. When combined with thin-cap fibroatheroma (TCFA) status, these parameters demonstrated enhanced predictive power: mean arc ≥ 97.88° + TCFA (HR = 8.779, P < 0.0001), maximum arc ≥ 157.5° + TCFA (HR = 8.149, P < 0.0001), and MAS ≥ 2.27 + TCFA (HR = 7.509, P < 0.0001). Notably, among TCFA-negative patients, a mean arc ≥ 97.88° showed markedly improved predictive capacity for MACEs (HR = 6.685, P < 0.001), as did maximum arc ≥ 157.5° (HR = 4.490, P < 0.001) and MAS ≥ 2.27 (HR = 5.126, P < 0.001).
CONCLUSION: Macrophage arc parameters are strongly associated with long-term cardiovascular risk, serving as novel OCT-derived biomarkers for patients with CAD.
PMID:42376680 | PMC:PMC13312119 | DOI:10.1093/ehjimp/qyag107
