Optical Coherence Tomography-Derived Macrophage Arc as a Novel Biomarker for Predicting Adverse Cardiovascular Events in Coronary Artery Disease: A Multicenter Study

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ID: 317172
2026
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Abstract
Abstract Background and 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 multicenter, 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 target vessel. Among 1,025 patients (1,173 vessels), 61(5.9%) experienced MACEs. Receiver operating characteristic (ROC) 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 macrophage 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.
Reference Key
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Authors Zelin Ou, Li Xie, Han Xiao, Bin Cui, K Wang, Yili Ma, Maoyu Zhao, Youzhu Qiu, Yao Zhang, Zhihui Zhang, Dehui Qian, Bin Liu, Xiaohui Zhao
Journal European Heart Journal - Imaging Methods and Practice
Year 2026
DOI
10.1093/ehjimp/qyag107
URL
https://doi.org/10.1093/ehjimp/qyag107
Keywords Keywords not found

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