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
Graphical Abstract
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Article Info
Publication History
Published online: July 12, 2022
Accepted:
July 7,
2022
Received:
February 1,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See page 10 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- You Wonder Where the Yellow WentCanadian Journal of Cardiology
- PreviewIn 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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