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 CAD (CCS/ACS=264/181) from the REASSURE-NIRS multi-center 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, non-fatal target lesion-related MI, or ischemia-driven TLR)
and patient-oriented clinical outcomes (POCO; all-cause death, non-fatal MI, or ischemia-driven
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=1.000, 95% CI=0.997–1.003, p=0.95). There was no
significant relationship between residual maxLCBI4mm and POCO (odds ratio=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 a newer-generation DES.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
ACS (acute coronary syndrome), BMS (bare-metal stent), CAD (coronary artery disease), CCS (chronic coronary syndrome), DES (drug-eluting stent), ID-TLR (ischemia-driven target lesion revascularization), IVUS (intravascular ultrasound), LCBI (lipid core burden index), LDL-C (low-density lipoprotein cholesterol), LOCO (lesion-oriented clinical outcome), MI (myocardial infarction), MLD (minimum lumen diameter), MSA (minimum stent area), NIRS (near-infrared spectroscopy), OCT (optical coherence tomography), PCI (percutaneous coronary intervention), %DS (percent diameter stenosis), POCO (patient-oriented clinical outcome), QCA (quantitative coronary angiography)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 7,
2022
Received in revised form:
July 6,
2022
Received:
February 1,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Clinical implication of underlying plaque characteristics at coronary lesions receiving newer-generation DES remains to be unknown. The residual lipidic burden (residual maxLCBI4mm) behind the implanted newer-generation DES was analyzed at 445 target lesions. During the 3-years-observational period, the residual maxLCBI4mm did not associate with the occurrence of lesion- and patient-oriented clinical outcomes. Clinical implication of maxLCBI4mm behind the implanted newer-generation DES at culprit lesions may be different from that at de novo non-culprit ones.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
