Thin-Cap Fibroatheroma and Major Adverse Cardiovascular Events: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::THIN_CAP_FIBROATHEROMA_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara74e16474

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Thin-Cap Fibroatheroma and Major Adverse Cardiovascular Events: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara74e16474

Editorial note

• Last update: 2026-06-15 13:43:37

What is this paper about

Thin-cap fibroatheroma identifies dangerous coronary plaques that may trigger major cardiovascular events even when stenosis is non-obstructive or FFR is negative. The full review reveals how TCFA can refine risk stratification, how lipid-lowering therapy may stabilize vulnerable plaques, and whether imaging-guided intervention could change outcomes.

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Abstract: To map the breadth and depth of original research on thin-cap fibroatheroma (TCFA), synthesizing evidence across detection modalities, prognostic implications, mechanistic pathways, risk stratification, and therapeutic interventions, in order to identify convergences, gaps, and emerging directions in the field. The review uses 225 references and builds its evidence map from 457 original studies with 112158 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that TCFA functions as a robust, modality-spanning marker of coronary plaque vulnerability that predicts adverse cardiovascular events independent of stenosis severity, persisting even in FFR-negative and angiographically non-obstructive lesions. The dominant signal is prognostic: OCT-defined TCFA was associated with substantially elevated event risk, including a hazard ratio of 4.65 for MACE in diabetic patients with FFR-negative lesions and lesion-level risk reaching 8.15 in post-MI populations. Converging evidence further suggests that intensive lipid-lowering therapy can stabilize these lesions, with statins reducing TCFA prevalence from 20.0% to 7.1% and PCSK9 inhibitors enhancing fibrous cap thickening. Practically, this supports incorporating TCFA assessment into risk stratification beyond ischemia-guided paradigms, while AI-augmented detection may improve reproducibility. The central remaining uncertainty is whether TCFA-guided intervention improves outcomes, highlighting the need for randomized trials testing preventive treatment of non-culprit TCFA against optimal medical therapy.
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Keywords: thin-cap fibroatheroma; optical coherence tomography; plaque vulnerability; fibrous cap thickness; lipid-rich plaque; intravascular imaging; major adverse cardiac events; coronary artery disease; fractional flow reserve; percutaneous coronary intervention

Review Stats

Final search date and database lock: 2026-06-03 18:00:59 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 700
Downloaded Abstracts/Papers: 700
Included original and non-original Abstracts/Papers (all): 520
Included original Abstracts/Papers (Vote counting by direction of effect): 457
Reference Index (links used in paper): 225
Total participants/sample observations (topic deduplicated ΣN): 112158

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Reference Index (225)

[1] Vulnerable or High-Risk Plaque: A JACC: Cardiovascular Imaging Position Statement. — https://doi.org/10.1016/j.jcmg.2024.12.004
[2] Thin-cap fibroatheroma in acute coronary syndrome: Implication for intravascular imaging assessment. — https://doi.org/10.1016/j.ijcard.2024.131965
[3] Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial. — https://doi.org/10.1093/eurheartj/ehab433
[4] Thin-cap fibroatheroma: the trigger of acute coronary syndromes. Pathophysiological and prognostic importance of in-vivo detection. — https://doi.org/10.1016/j.ijcard.2024.132157
[5] Thin-cap fibroatheroma rupture is associated with a fine interplay of shear and wall stress. — https://doi.org/10.1161/atvbaha.114.303426
[6] Enhanced Plaque Stabilization Effects of Alirocumab　- Insights From Artificial Intelligence-Aided Optical Coherence Tomography Analysis of the Alirocumab for Thin-Cap Fibroatheroma in Patients With Coronary Artery Disease Estimated by Optical Coherence Tomography (ALTAIR) Study. — https://doi.org/10.1253/circj.cj-24-0480
[7] Thin-cap fibroatheroma association with local inflammatory activity in coronary disease: an optical-coherence tomography study. — https://doi.org/10.31744/einstein_journal/2025ao1592
[8] Computed Tomography Angiography Characteristics of Thin-Cap Fibroatheroma in Patients With Diabetes. — https://doi.org/10.1161/jaha.123.033639

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