Target Lesion Lipid Content Detected by Near-Infrared Spectroscopy After Stenting and the Risk of Subsequent Target Lesion Failure

Abstract

Objective: After percutaneous coronary intervention (PCI), it is unknown whether retained lipid content in the stented segment increases the risk of target lesion failure (TLF). This study evaluated the association between retained lipid content in the stented segment detected by post-PCI intracoronary near-infrared spectroscopy and TLF. Approach and Results: After the performance of PCI, post-PCI near-infrared spectroscopy–intravascular ultrasound images were acquired and analyzed by an independent core laboratory for retained lipid content in the stented segment, quantified by the maximum lipid core burden index in 4 mm (maxLCBI 4mm ). The primary outcome was TLF during follow-up, defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 202 patients with 209 target lesions treated by PCI and followed for 3.5±1.4 years, baseline post-PCI near-infrared spectroscopy–intravascular ultrasound images revealed a significantly greater maxLCBI 4mm in stented lesions with (297 [211, 401]) versus without (119 [9, 258]) TLF during follow-up ( P =0.006). By multivariate logistic regression, maxLCBI 4mm in the stented segment was independently associated with subsequent TLF (odds ratio, 1.6 [95% CI, 1.2–2.1] for every 100-unit increase, P =0.004). By receiver-operating characteristic analysis, the optimal residual maxLCBI 4mm threshold in the stented segment for subsequent TLF was 200. Stented lesions with a residual maxLCBI 4mm >200 had significantly greater TLF during follow-up than stented lesions with a maxLCBI 4mm ≤200 (15.0% versus 3.1%, P =0.002). Conclusions: Retained lipid content detected by near-infrared spectroscopy in the stented segment after PCI was associated with an increased risk of subsequent TLF.

Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept

“…NIRS is capable of recognizing lipid components (lipid core plaque—a potential clinical correlate of the “vulnerable plaque”), particularly lipid-rich TCFAs. Madder et al explored the relationship between large, lipid-rich plaques (LRPs) identified by NIRS technology at non-culprit segments (locations of a culprit vessel that were not stented) and future major adverse coronary and cerebrovascular events (MACCE) [ 48 ] ( Figure 3 ). Large LRP was defined as “a maximum lipid core burden index in 4-mm (maxLCBI4mm) ≥500”.…”