2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques

Myong Hwa Yamamoto, Akiko Maehara, Gregg W. Stone, Annapoorna S. Kini, Emmanouil S. Brilakis, David G. Rizik, Kendrick Shunk, Eric R. Powers, Jonathan M. Tobis, Brijeshwar S. Maini, Simon R. Dixon, James A. Goldstein, John L. Petersen, Philippe Généreux, Priti R. Shah, Aaron Crowley, Stephen J. Nicholls, Gary S. Mintz, James E. Muller, Giora Weisz

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Abstract

Background: Autopsy studies suggest that implanting stents in lipid-rich plaque (LRP) may be associated with adverse outcomes. Objectives: The purpose of this study was to evaluate the association between LRP detected by near-infrared spectroscopy (NIRS) and clinical outcomes in patients with coronary artery disease treated with contemporary drug-eluting stents. Methods: In this prospective, multicenter registry, NIRS was performed in patients undergoing coronary angiography and possible percutaneous coronary intervention (PCI). Lipid core burden index (LCBI) was calculated as the fraction of pixels with the probability of LRP >0.6 within a region of interest. MaxLCBI4mm was defined as the maximum LCBI within any 4-mm-long segment. Major adverse cardiac events (MACE) included cardiac death, myocardial infarction, definite or probable stent thrombosis, or unplanned revascularization or rehospitalization for progressive angina or unstable angina. Events were subcategorized as culprit (treated) lesion–related, nonculprit (untreated) lesion–related, or indeterminate. Results: Among 1,999 patients who were enrolled in the COLOR (Chemometric Observations of Lipid Core Plaques of Interest in Native Coronary Arteries Registry), PCI was performed in 1,621 patients and MACE occurred in 18.0% of patients, of which 8.3% were culprit lesion–related, 10.7% were nonculprit lesion–related, and 3.1% were indeterminate during 2-year follow-up. Complications from NIRS imaging occurred in 9 patients (0.45%), which resulted in 1 peri-procedural myocardial infarction and 1 emergent coronary bypass. Pre-PCI NIRS imaging was obtained in 1,189 patients, and the 2-year rate of culprit lesion–related MACE was not significantly associated with maxLCBI4mm (hazard ratio of maxLCBI4mm per 100: 1.06; 95% confidence interval: 0.96 to 1.17; p = 0.28) after adjusting clinical and procedural factors. Conclusions: Following PCI with contemporary drug-eluting stents, stent implantation in NIRS-defined LRPs was not associated with increased periprocedural or late adverse outcomes compared with those without significant lipid.

Original languageEnglish (US)
Pages (from-to)1371-1382
Number of pages12
JournalJournal of the American College of Cardiology
Volume75
Issue number12
DOIs
StatePublished - Mar 31 2020

Keywords

  • intravascular ultrasound
  • lipid-rich plaque
  • near-infrared spectroscopy
  • stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Yamamoto, M. H., Maehara, A., Stone, G. W., Kini, A. S., Brilakis, E. S., Rizik, D. G., Shunk, K., Powers, E. R., Tobis, J. M., Maini, B. S., Dixon, S. R., Goldstein, J. A., Petersen, J. L., Généreux, P., Shah, P. R., Crowley, A., Nicholls, S. J., Mintz, G. S., Muller, J. E., & Weisz, G. (2020). 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques. Journal of the American College of Cardiology, 75(12), 1371-1382. https://doi.org/10.1016/j.jacc.2020.01.044