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Canadian Journal of Cardiology

The Residual Lipid-Rich Coronary Atheroma Behind the Implanted Newer-Generation Drug-Eluting Stent and Future Stent-Related Event Risks

      Abstract

      Background

      Lipid-rich plaque is an important substrate that causes future coronary events. However, the clinical implications of underlying plaque characteristics in coronary lesions after newer-generation drug-eluting stent (DES) implantation remain unknown.

      Methods

      The current study analyzed 445 target lesions after newer-generation DES implantation in 416 patients with coronary artery disease (CAD) (chronic coronary syndrome/acute coronary syndrome [CCS/ACS] = 264/181) from the REASSURE-NIRS multicentre registry. Near-infrared spectroscopy (NIRS) imaging was used to evaluate maximum lipid core burden index after stent implantation in target lesions (residual maxLCBI4mm). The primary and secondary outcomes were 3-year lesion-oriented clinical outcomes (LOCO): cardiac death, nonfatal target-lesion–μrelated myocardial infarction (MI), or ischemia-driven target-lesion revascularization (ID-TLR) and patient-oriented clinical outcomes (POCO): all-cause death, nonfatal MI, or ID unplanned revascularization. Outcomes were compared by residual maxLCBI4mm tertile.

      Results

      Median residual maxLCBI4mm was 183; 16% of lesions had residual maxLCBI4mm > 400. Higher residual maxLCBI4mm was not associated with a greater likelihood of LOCO or POCO during the observational period (LOCO, log-rank P = 0.76; POCO, log-rank P = 0.84). Mixed-effects logistic regression demonstrated that residual maxLCBI4mm does not predict LOCO (odds ratio [OR], 1.000; 95% confidence interval [CI], 0.997-1.003; P = 0.95). There was no significant relationship between residual maxLCBI4mm and POCO (OR, 1.001; 95% CI, 0.999-1.002; P = 0.30).

      Conclusions

      Residual maxLCBI4mm is not associated with LOCO or POCO in patients with CAD after newer-generation DES implantation. Our findings suggest that NIRS-derived underlying lipid-rich plaque is not associated with the risk of stent-related events and patient-based outcomes in patients with CAD who have received newer-generation DESs.

      Résumé

      Contexte

      Les plaques d’athérome à haute teneur en lipides jouent un rôle important dans la survenue d'incidents coronariens subséquents. Toutefois, les implications cliniques des caractéristiques sous-jacentes dans les lésions coronariennes après la mise en place d’une endoprothèse à élution médicamenteuse (EEM) de nouvelle génération demeurent mal comprises.

      Méthodologie

      Dans le cadre de cette étude, nous avons analysé 445 lésions cibles après la mise en place d’une EEM de nouvelle génération, chez 416 patients atteints d’une coronaropathie (syndrome coronarien chronique/syndrome coronarien aigu [SCC/SCA] = 264/181) inscrits au registre multicentrique REASSURE-NIRS. La spectroscopie proche infrarouge (SPIR) a été utilisée pour déterminer la valeur maximale de l’indice du fardeau lié à la présence de plaques avec noyaux lipidiques (lipid core burden index) pour les lésions cibles après la mise en place de l’endoprothèse (LCBI4 mm maximal résiduel). Le critère d’évaluation principal et le critère d’évaluation secondaire étaient respectivement les résultats cliniques liés aux lésions (LOCO, pour lesion-oriented clinical outcomes) après trois ans, c’est-à-dire les décès attribuables à des causes cardiaques, l’infarctus du myocarde (IM) non fatal lié à la lésion et la revascularisation de la lésion cible en raison d’une ischémie (RLC-CI), et les résultats cliniques liés aux patients (POCO, pour patient-oriented clinical outcomes), c’est-à-dire les décès toutes causes confondues, l’IM non fatal, et la revascularisation non planifiée en raison d’une ischémie. Les résultats cliniques ont été comparés selon le tertile de la valeur de LCBI4 mm maximal résiduel.

      Résultats

      La valeur médiane du LCBI4 mm maximal résiduel était de 183; 16 % des lésions ont obtenu un score de LCBI4 mm maximal résiduel > 400. Les valeurs de LCBI4mm maximal résiduel plus élevées n’étaient pas associées à une probabilité supérieure de LOCO ou de POCO au cours de la période d’observation (LOCO, test de Mantel-Haenszel = 0,76; POCO, test de Mantel-Haenszel = 0,84). L’analyse par régression logistique à effets mixtes a démontré que le LCBI4mm maximal résiduel ne permettait pas de prédire les LOCO (rapport de cotes [RC], 1,000; intervalle de confiance [IC] à 95 % de 0,997 à 1,003; P = 0,95). Aucune association significative n’a été notée entre le LCBI4 mm maximal résiduel et les POCO (RC, 1,001; IC à 95 % de 0,999 à 1,002; P = 0,30).

      Conclusions

      Les valeurs de LCBI4 mm maximal résiduel ne sont associées ni aux LOCO ni aux POCO chez les patients atteints d’une coronaropathie après la mise en place d’une EEM de nouvelle génération. Selon nos observations, la détection par SPIR des plaques d’athérome à haute teneur en lipides n’est pas associée au risque d’événements liés à l’endoprothèse ou aux résultats cliniques chez les patients atteints d’une coronaropathie pour lesquels une EEM de nouvelle génération a été implantée.

      Graphical abstract

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      Linked Article

      • You Wonder Where the Yellow Went
        Canadian Journal of Cardiology
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          In this issue of the Canadian Journal of Cardiology, Murai et al. tested the hypothesis “that NIRS-derived lipidic parameters after PCI could identify lesions or patients associated with future cardiac events.”1 Patients were derived from Revelation of Pathophysiological Phenotypes of Vulnerable Lipid-Rich Plaque on Near-Infrared Spectroscopy (REASSURE-NIRS) (NCT04864171), an ongoing prospective multicentre registry in Japan that enrolls consecutive patients with coronary artery disease who undergo percutaneous coronary intervention (PCI) with near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) imaging.
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