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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’s 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 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

      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)
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